H. pylori infections
Helicobacter pylori (H. pylori) is a bacterium commonly found in the human digestive tract. It can cause ulcers in the stomach lining or the upper part of the small intestines and result in stomach cancer in some cases. Approximately two-thirds of the people in the world have H. pylori in their bodies. In most people it H. pylori does not cause ulcers or other symptoms. In case an individual develops symptoms, there are medications to treat the infection and help in healing sores. The number of H. pylori infections continues to reduce worldwide as more people get access to clean water and sanitation.
- pylori Treatment and Metachronous Gastric Cancer
Choi et al. (2018) investigated treatment options for H. pylori that prevent metachronous gastric cancer. Patients with early gastric cancers in the submucosa or gastric mucosa often experience a progressive loss of glandular atrophy (mucosa glandular tissue), putting them at a high risk of metachronous (subsequent) development of new gastric cancer. Choi et al. (2018) designed a trial to assess the effect of H. pylori treatment in preventing metachronous cancer and decreasing histologic changes in early gastric cancer patients.
Methods and Techniques
The research method used was a single-center, double-blind, randomized, placebo-controlled trial at the National Cancer Center in South Korea. All the patients provided informed consent, and the review board at the Center approved the trial (Choi et al., 2018, p.1086). Eligible patients were aged between 18 and 75 years and had histologically differentiated early gastric cancer or high-grade adenoma. Exclusion criteria included recurrent gastric cancer, current H. pylori infection, and another form of cancer within the previous five years, among others.
Patients were randomly assigned to receive either placebo or H. pylori eradication treatment in the ratio 1:1. Randomization was computer-generated with p.status all patients, the statistician, pathologist, endoscopist, and the primary physician blinded. Patients in the treatment group received amoxicillin (1000 mg), clarithromycin (500 mg), and the proton-pump inhibitor rabeprazole (10 mg) twice daily for 7 days, while those in the placebo group received rabeprazole (10 mg) and placebo pills, with proton-pump inhibitor maintained in both groups. Follow-up was done at 3 months, 6 months, 1 year, and every 6 months or 12 months until the last enrolled patient reached a 3-year follow-up. The outcomes include two primary (incidence of metachronous gastric cancer and improvement from baseline) and two secondary outcomes (incidence of metachronous adenoma and the overall survival rate) (Choi et al., 2018, p.1087).
Summary of Findings
Of the 470 patients randomized, 194 were in the treatment group, 202 in the placebo group, and 74 were excluded. For the first primary outcome with a median follow-up of 5.9 years, metachronous cancer developed in 14 (7.2%) patients in the treatment group and 27 (13.4%) in the placebo group. For the second primary outcome, a higher number of patients had an improved grade of atrophy than in the placebo group (48.4% versus 15.0%). For the secondary outcomes, 16 patients in the treatment group and 17 in the placebo group developed metachronous adenomas. 11 patients in the treatment group and 6 in the placebo group died (Choi et al., 2018, p.1087-88). From these findings, the researchers concluded that H. pylori treatment in early gastric cancer patients reduced the incidence of metachronous gastric cancer and lead to better improvement compared to the baseline in the grade of gastric glandular atrophy than patients in the placebo group (Choi et al., 2018, p.1094).