Esophagus to Small Intestine

Nat Med. 2024;30(11):3250–60

Pan KF, Li WQ, Zhang L, Liu WD, Ma JL, Zhang Y, Ulm K, Wang JX, Zhang L, Bajbouj M, Zhang LF, Li M, Vieth M, Quante M, Wang LH, Suchanek S, Mejías-Luque R, Xu HM, Fan XH, Han X, Liu ZC, Zhou T, Guan WX, Schmid RM, Gerhard M, Classen M, You WC

Gastric cancer prevention by community eradication of Helicobacter pylori: A cluster-randomized controlled trial

Gastric cancer is a leading cause of cancer-related deaths in China. Affecting more than 40% of the world’s population, Helicobacter pylori is a major risk factor for gastric cancer. While previous clinical trials indicated that eradication of H. pylori could reduce gastric cancer risk, this remains to be shown using a population-based approach. The authors conducted a community-based, cluster-randomized, controlled, superiority intervention trial in Linqu County, China, with individuals who tested positive for H. pylori using a 13C-urea breath test randomly assigned to receiving either (1) a 10-day, quadruple anti-H. pylori treatment (comprising 20 mg of omeprazole, 750 mg of tetracycline, 400 mg of metronidazole and 300 mg of bismuth citrate) or (2) symptom alleviation treatment with a single daily dosage of omeprazole and bismuth citrate. H. pylori-negative individuals did not receive any treatment. The incidence of gastric cancer was examined as the primary outcome. A total of 180,284 eligible participants from 980 villages were enrolled over 11.8 years of follow-up, and a total of 1035 cases of incident gastric cancer were documented. Individuals receiving anti-H. pylori therapy showed a modest reduction in gastric cancer incidence in intention-to-treat analyses (hazard ratio [HR] = 0.86, 95% confidence interval [CI]: 0.74–0.99), with a stronger effect observed for those having successful H. pylori eradication (HR = 0.81, 95% CI: 0.69–0.96) than for those who failed treatment. Moderate adverse effects were reported in 1345 participants during the 10-day treatment. The authors observed no severe intolerable adverse events during either treatment or follow-up.

These findings suggest the potential for Helicobacter pylori mass screening and eradication as a public health policy for gastric cancer prevention.

K.-F. Pan or W.-Q. Li, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China, E-Mail: pan-kf@263.net or E-Mail: wenqing_li@bjmu.edu.cn

or

M. Gerhard, Institut für Medizinische Mikrobiologie und Immunologie, TUM School of Medicine and Health, Munich, Germany, E-Mail: markus.gerhard@tum.de

or

W.-C. You, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China, E-Mail: weichengyou2022@outlook.com

DOI: 10.1038/s41591-024-03153-w

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