Long-term data confirm benefit of H. pylori treatment in gastric cancer

By Reuters Staff

NEW YORK (Reuters Health) - 24/9/2019

Antibiotic treatment of Helicobacter pylori reduces the incidence of gastric cancer and possibly related deaths, and supplementation with vitamins or garlic may also hold promise, according to long-term follow-up of the Shandong Intervention Trial.

The original trial, which included 3,365 participants, found a significant reduction in gastric cancer incidence and a nonsignificant reduction in deaths due to gastric cancer associated with two weeks of H. pylori treatment 15 years earlier. Garlic and vitamin supplementation showed favorable trends for both outcomes that did not reach statistical significance.

In the current study, Dr. Kai-Feng Pan of Peking University Cancer Hospital and Institute, in Beijing, and colleagues report the same outcomes 22.3 years after randomization, at which point there had been 151 incident cases of gastric cancer and 94 deaths from the malignancy.

In multivariable analyses, H. pylori treatment was associated with 52% lower odds of gastric cancer (P<0.001) and vitamin supplementation was associated with 36% lower odds of the disease (P=0.01), whereas garlic supplementation did not significantly alter the risk of gastric cancer (adjusted odds ratio, 0.81; P=0.22).

H. pylori treatment reduced the risk of gastric-cancer deaths by 38% (0.62; P=0.05), vitamin supplementation cut it by 52% (P=0.001) and garlic supplementation by 34% (P=0.05), the researchers report in The BMJ, online September 11.

The protective effect on gastric-cancer mortality emerged after about eight years for H. pylori treatment and vitamin supplementation and after about 12 years for garlic supplementation.

"These findings suggest many potential strategies for gastric cancer prevention," the researchers conclude. "However, before major public health campaigns for gastric cancer prevention are launched utilizing antibiotic based H. pylori treatment or nutritional regimens, further large scale intervention trials are warranted to delineate the full range of beneficial and adverse effects of H. pylori treatment, to confirm the preventive effects of vitamin and garlic supplementation, and to identify possible risks from nutritional regimens."

The trial had government funding from both the U.S. and China. Wakunaga of America performed assays of S-allyl cysteine and provided garlic supplements; Shanghai Squibb provided vitamin supplements; and Astra Corporation provided amoxicillin and omeprazole. The researchers report no conflicts of interest.

Dr. Pan did not respond to a request for comments.

SOURCE: https://bit.ly/2l9ov2y

BMJ 2019

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