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Effect of Helicobacter pylori eradication and high-density lipoprotein on the risk of de novo gastric cancer development

Published:April 26, 2019DOI:https://doi.org/10.1016/j.gie.2019.04.232

      Background and Aims

      The effect of Helicobacter pylori eradication on de novo gastric cancer is controversial, although meta-analyses suggest a reduction in gastric cancer after eradication. The effect of high-density lipoprotein (HDL) on gastric cancer has been rarely reported.

      Methods

      In this large retrospective cohort study, participants underwent endoscopy and H pylori testing from 2003 to 2011 and underwent follow-up endoscopy and H pylori testing until 2013. H pylori infection was detected using a rapid urease test or histologic test. The H pylori eradication group was defined as successful eradication, whereas the H pylori persistent group was defined as noneradication or eradication failure. The risk of cancer was measured with hazard ratios (HRs) and 95% confidence intervals (CIs).

      Results

      Among 10,328 healthy subjects (5951 men; mean age, 48.7 years), 31 gastric cancers were detected during a median follow-up of 5.5 years. De novo gastric cancer developed in 21 of 3508 subjects (.6%) in the noneradication group, 4 of 2050 subjects (.2%) in the successful eradication group, and 6 of 4770 participants (.13%) in the absence of H pylori group. In the adjusted analysis, H pylori eradication decreased de novo gastric cancer risk (HR, .29; 95% CI, .10-.86) compared with the persistent group. The risk of de novo gastric cancer in absence of H pylori was also much lower compared with the persistent group (HR, .24; 95% CI, .09-.60). Low serum HDL increased the risk of de novo gastric cancer (HR, 2.67; 95% CI, 1.14-6.16).

      Conclusions

      Successful H pylori eradication reduced de novo gastric cancer, whereas low HDL increased its risk.

      Graphical abstract

      Abbreviations:

      AGC (advanced gastric cancer), BMI (body mass index), CI (confidence interval), EGC (early gastric cancer), HDL (high-density lipoprotein), HR (hazard ratio), LDL (low-density lipoprotein), RCT (randomized controlled trial)
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      Linked Article

      • Gastric cancer risk stratification and surveillance after Helicobacter pylori eradication: 2020
        Gastrointestinal EndoscopyVol. 90Issue 3
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          Gastric cancer remains one of the most common causes of cancer deaths worldwide. The best current option for reducing gastric cancer deaths is Helicobacter pylori eradication combined with risk assessment and surveillance programs for those deemed to be at high risk for gastric cancer so as to identify lesions at a stage amenable to curative therapy. In this issue, Nam et al1 report a retrospective study of Helicobacter pylori eradication on gastric cancer incidence among 10,328 Korean adults undergoing health checkups including an H pylori test-and-treat program.
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