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World J Gastroenterol. May 21, 2014; 20(19): 5660-5665
Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5660
Helicobacter pylori eradication for preventing gastric cancer
Bin Lu, Meng Li
Bin Lu, Meng Li, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Lu B ideated and edited the manuscript; Lu B and Li M performed the review of the literature; Li M provided the primary draft of the manuscript; all authors read and approved the final version to be published.
Correspondence to: Bin Lu, MD, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. lvbin@medmail.com.cn
Telephone: +86-571-8703-2028 Fax: +86-571-8707-7785
Received: October 3, 2013
Revised: November 15, 2013
Accepted: January 3, 2014
Published online: May 21, 2014
Abstract

Helicobacter pylori (H. pylori) infection is a major risk factor for gastric cancer (GC) development, which is one of the most challenging malignant diseases worldwide with limited treatments. In the multistep pathogenesis of GC, H. pylori infection slowly induces chronic active gastritis, which progresses through the premalignant stages of atrophic gastritis, intestinal metaplasia, and dysplasia, and then finally to GC. Although eradication of H. pylori is a reasonable approach for the prevention of GC, there have been some contradictory reports, with only some long-term follow-up data showing efficacy of this approach. The inconsistencies are likely due to the insufficient number of participants, relatively short follow-up periods, poor quality of study designs, and the degree and extent of preneoplastic changes at the time of H. pylori eradication. This review analyzes recent high-quality studies to resolve the discrepancies regarding the eradication of H. pylori for GC prevention. The relationship between H. pylori eradication and GC/precancerous lesions/metachronous GC is examined, and the cost-effectiveness of this strategy in the prevention of GC is assessed. Although it is assumed that eradication of H. pylori has the potential to prevent GC, the feasibility and appropriate timing of this strategy for cancer prevention remain to be determined. As a result, additional well-designed trials with longer follow-up periods are needed to clarify this issue.

Keywords: Helicobacter pylori, Gastric cancer, Cancer prevention

Core tip: The treatment of gastric cancer (GC) is challenging. Elimination of a major risk factor, Helicobacter pylori (H. pylori) infection, represents an important approach for the prevention of GC. However, the feasibility and appropriate timing of this strategy remain to be determined. This review highlights the most recent literature and presents a comprehensive evaluation of what is currently known about H. pylori infections and GC.