eradication of Helicobacter pylori (H. pylori) and gastric cancer risk

A community-based, cluster-randomized, controlled, superiority intervention trial was undertaken in Linqu County, China, with individuals who tested positive for H. pylori using a ¹³C-urea breath test randomly assigned to receiving either (1):

• (1) a 10-day, quadruple anti-H. pylori treatment (comprising 20 mg of omeprazole, 750 mg of tetracycline, 400 mg of metronidazole and 300 mg of bismuth citrate) or
• (2) symptom alleviation treatment with a single daily dosage of omeprazole and bismuth citrate

• H. pylori-negative individuals did not receive any treatment
• incidence of gastric cancer was the primary outcome
• total of 180,284 eligible participants from 980 villages were enrolled over 11.8 years of follow-up, and a total of 1,035 cases of incident gastric cancer were documented
  • individuals receiving anti-H. pylori therapy showed a modest reduction in gastric cancer incidence in intention-to-treat analyses (hazard ratio 0.86, 95% confidence interval 0.74-0.99), with a stronger effect observed for those having successful H. pylori eradication (hazard ratio 0.81, 95% confidence interval 0.69-0.96) than for those who failed treatment
• study authors concluded:
  • findings suggest the potential for H. pylori mass screening and eradication as a public health policy for gastric cancer prevention

In a meta-analysis of randomized controlled trials and observational studies there was consistent evidence that H pylori eradication therapy prevents gastric cancer (2):

• data was pooled from RCTs conducted among healthy H pylori–positive individuals without gastric cancer at baseline
  • when all RCTs were pooled together, irrespective of the population under study, there was a 39% reduction in the relative risk of future incidence of gastric cancer occurring among those receiving eradication therapy, compared with those receiving placebo or no eradication therapy

Reference:

1. Pan KF et al. Gastric cancer prevention by community eradication of Helicobacter pylori: a cluster-randomized controlled trial. Nat Med. 2024 Nov;30(11):3250-3260.
2. Ford AC et al. Eradication Therapy to Prevent Gastric Cancer in Helicobacterpylori-Positive Individuals: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Gastroenterology. 2025 Aug;169(2):261-276.