Best to Eradicate H Pylori in Patients with Precancerous Gastric Lesions

NEW YORK NOV 04, 2005 (Reuters Health) - The results of a long-term study suggest that eradication of Helicobacter pylori infection is a worthwhile goal in adults with preneoplastic gastric lesions.

After a follow-up of 12 years, clearing H. pylori infection had a "strong and significant effect" towards the healing of gastric precancerous lesions, study investigators report in the November issue of the journal Gut.

"This effect is cumulative and compounded through time, so the longer the patient is free of the infection, the faster and more thoroughly the healing occurs," Dr. Pelayo Correa from Louisiana State University Health Sciences Center, New Orleans and colleagues also note.

Their study involved 795 adults with preneoplastic gastric lesions from an area of Colombia known for its high prevalence of gastric cancer and precancerous gastric lesions.  The subjects were randomly assigned to anti-H. pylori triple therapy, with or without supplemental ascorbic acid and beta-carotene.  At the end of six years, subjects not on anti-H. pylori therapy were offered it.  Gastric biopsies obtained at baseline, and at 3, 6, and 12 years.

Nearly all of the subjects (97%) were H. pylori-positive at baseline, whereas 53% were positive at 12 years.

Among the 394 subjects who received anti-H. pylori therapy at baseline, eradication rates at 3, 6 and 12 years were 51%, 75%, and 51%, respectively.  The eradication rate at 12 years for the 180 subjects who did not receive anti-H pylori therapy at baseline but who offered and received it at the 6-year mark was 47%.

A multivariate model showed a significant regression in gastric lesions as H. pylori-negative time increased.  According to the team, "subjects who were H. pylori-negative had 14.8% more regression and 13.7% less progression than patients who were positive at 12 years (p = 0.001)."

"The rate of healing of gastric lesions occurred more rapidly as years free of infection accumulated, and was more pronounced in less advanced lesions," Dr. Correa and colleagues also report.

"Our study," they conclude, "indicates that gastric cancer chemoprevention via eradication of H. pylori is a viable option, but the greatest beneficial effects might not be evident in the first 3-6 years of observation. Our findings suggest that patients with preneoplastic gastric lesions should be treated and cured of their H. pylori infection."

SOURCE:

• Gut 2005;54:1536-1540.