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Helicobacter pylori and Gastrointestinal Malignancies
Author(s) -
Venerito Marino,
Vasapolli Riccardo,
Rokkas Theodoros,
Malfertheiner Peter
Publication year - 2015
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12255
Subject(s) - helicobacter pylori , medicine , intestinal metaplasia , gastroenterology , urea breath test , rapid urease test , dysplasia , cancer , breath test , atrophic gastritis , gastritis , helicobacter pylori infection
Helicobacter pylori infection is the principal trigger of gastric carcinogenesis and gastric cancer ( GC ) and remains the third leading cause of cancer‐related death in both sexes worldwide. In a big Japanese study, the risk of developing GC in patients with peptic ulcer disease who received H. pylori eradication therapy and annual endoscopic surveillance for a mean of 9.9 years was significantly lower after successful eradication therapy compared to the group with persistent infection (0.21%/year and 0.45%/year, respectively, p = .049). According to a recent meta‐analysis, H. pylori eradication is insufficient in GC risk reduction in subjects with advanced precancerous conditions (i.e., intestinal metaplasia and dysplasia). A microsimulation model suggested screening smokers over the age of 50 in the U.S. for serum pepsinogens. This would allow to detect advanced gastric atrophy with endoscopic follow‐up of subjects testing positive as a cost‐effective strategy to reduce GC mortality. In a Taiwanese study, the anti‐ H. pylori IgG‐based test‐and‐treat program had lower incremental cost‐effectiveness ratios than that with 13 C‐urea breath test in both sexes to prevent GC whereas expected years of life lost for GC were higher and the incremental cost‐effectiveness ratios of test‐and‐treat programs were more cost‐effective in young adults (30–69 years old) than in elders (>70 years old). With respect to gastrointestinal malignancies other than GC , a meta‐analysis confirmed the inverse association between H. pylori infection and esophageal adenocarcinoma. In a Finnish study, H. pylori seropositivity was associated with an increased risk of biliary tract cancers (multivariate adjusted OR 2.63; 95% CI : 1.08–6.37), another meta‐analysis showed a slightly increased rate of pancreatic cancer in patients with CagA‐negative strains ( OR : 1.30; 95% CI : 1.02–1.65), whereas current data suggest that the association between H. pylori and colorectal neoplasms may be population dependent.