Eradication Therapy to Prevent Gastric Cancer in H. pylori-positive individuals: Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies
Abstract
BACKGROUND & AIMS
Screening for, and treating, Helicobacter pylori (H. pylori) in the general population or patients with early gastric neoplasia could reduce incidence of, and mortality from, gastric cancer. We updated a meta-analysis of randomized controlled trials (RCTs) examining this issue.
METHODS
We searched the literature through 4th October 2024, identifying studies examining effect of eradication therapy on incidence of gastric cancer in H. pylori-positive adults without gastric neoplasia at baseline or H. pylori-positive patients with gastric neoplasia undergoing endoscopic mucosal resection (EMR) in either RCTs or observational studies. The control arm received placebo or no eradication therapy in RCTs and no eradication therapy in observational studies. Follow-up was ≥2 years. We estimated relative risks (RR) of gastric cancer incidence and mortality.
RESULTS
Eleven RCTs and 13 observational studies were eligible. For RCTs, RR of gastric cancer was lower with eradication therapy in healthy H. pylori-positive individuals (eight RCTs: 0.64; 95% CI 0.48-0.84) and H. pylori-positive patients with gastric neoplasia undergoing EMR (three RCTs: 0.52; 95% CI 0.38-0.71). RR of death from gastric cancer was lower with eradication therapy in healthy H. pylori-positive individuals (five RCTs: 0.78; 95% CI 0.62-0.98). In observational studies, RR of future gastric cancer was lower with eradication therapy in H. pylori-positive subjects without gastric neoplasia at baseline…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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