Esophagus to Small Intestine
Gastroenterology. 2024;166(2):313–22.e3
Helicobacter pylori treatment and gastric cancer risk after endoscopic resection of dysplasia: A nationwide cohort study
Background and aims: The study investigated the association between Helicobacter pylori treatment and the risk of gastric cancer (GC) after endoscopic resection of gastric dysplasia.
Methods: Patients who received endoscopic resection for gastric dysplasia between 2010 and 2020 from Korean nationwide insurance data were included. The authors verified the occurrence of new-onset GC and metachronous gastric neoplasm, which encompasses both cancer and dysplasia, > 1 year after the index endoscopic resection. Newly diagnosed GC ≥ 3 years and ≥ 5 years was regarded as late-onset GC. A multivariable Cox regression model with H. pylori treatment status as a time-dependent covariate was used to determine the risk of GC and metachronous gastric neoplasms.
Results: Gastric dysplasia in 69,722 patients was treated with endoscopy, and 49.5% were administered H. pylori therapy. During the median 5.6 years of follow-up, GC developed in 2406 patients and metachronous gastric neoplasms developed in 3342 patients. Receiving H. pylori therapy was closely related to lower GC risk (adjusted hazard ratio [aHR] = 0.88; 95% confidence interval [CI]: 0.80-0.96). H. pylori treatment also significantly decreased metachronous gastric neoplasm development (aHR = 0.76; 95% CI: 0.70-0.82). Furthermore, H. pylori therapy showed a prominent protective effect for late-onset GC development at ≥ 3 years (aHR = 0.84; 95% CI: 0.75–0.94) and ≥ 5 years (aHR = 0.80; 95% CI: 0.68–0.95).
Conclusions: In this nationwide cohort, Helicobacter pylori therapy after endoscopic resection of gastric dysplasia was associated with a reduced risk of gastric cancer and metachronous gastric neoplasm occurrence.