Esophagus to Small Intestine

Gastroenterology. 2023;165(2):391–401.e2

Li D, Jiang SF, Lei NY, Shah SC, Corley DA

Effect of Helicobacter pylori eradication therapy on the incidence of non-cardia gastric adenocarcinoma in a large diverse population in the United States

Background and aims: High-quality data regarding the effect of Helicobacter pylori eradication on the risk of non-cardia gastric adenocarcinoma (NCGA) remain limited in the United States. The authors investigated the incidence of NCGA after H. pylori eradication therapy in a large, community-based US population.
Methods: They performed a retrospective cohort study of Kaiser Permanente Northern California members who underwent testing and/or treatment for H. pylori between 1997 and 2015 and were followed through December 31, 2018. The risk of NCGA was evaluated using the Fine-Gray subdistribution hazard model and standardized incidence ratios.
Results: Among 716,567 individuals with a history of H. pylori testing and/or treatment, the adjusted subdistribution hazard ratios and 95% confidence intervals of NCGA for H. pylori-positive/untreated and H. pylori-positive/treated individuals were 6.07 (4.20–8.76) and 2.68 (1.86–3.86), respectively, compared with H. pylori-negative individuals. When compared directly with H. pylori-positive/untreated individuals, subdistribution hazard ratios for NCGA in H. pylori-positive/treated were 0.95 (0.47–1.92) at < 8 years and 0.37 (0.14–0.97) ≥ 8 years of follow-up. Compared with the Kaiser Permanente Northern California general population, standardized incidence ratios (95% confidence interval) of NCGA steadily decreased after H. pylori treatment: 2.00 (1.79–2.24) ≥ 1 year, 1.01 (0.85–1.19) ≥ 4 years, 0.68 (0.54–0.85) ≥ 7 years, and 0.51 (0.38–0.68) ≥ 10 years.

Conclusion: In a large, diverse, community-based population, Helicobacter pylori eradication therapy was associated with a significantly reduced incidence of non-cardia gastric adenocarcinoma after 8 years compared with no treatment. The risk among treated individuals became lower than the general population after 7 to 10 years of follow-up. The findings support the potential for substantial gastric cancer prevention in the United States through H. pylori eradication.

D. Li, M.D., Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, CA, USA, E-Mail:

DOI: 10.1053/j.gastro.2023.04.026

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