מתוך medicontext.co.il
By Will Boggs, MD
WESTPORT, CT (Reuters Health) – Persons infected with Helicobacter pylori face a higher risk of gastric cancer than uninfected persons do, according to a report in the September 13th issue of The New England Journal of Medicine.
Recent studies investigating the possible link between H. pylori infection and gastric cancer have yielded conflicting results, the authors note, with some showing an association and others not.
Dr. Naomi Uemura from Kure Kyosai Hospital, Kure City, Japan, and colleagues therefore tested 1526 patients diagnosed with gastric or duodenal ulcers, gastric hyperplastic polyps, or nonulcer dyspepsia for H. pylori infection and then endoscopically followed them for evidence of gastric cancer over an average of 7.8 years.
According to the report, 1246 patients had H. pylori infection at baseline. These patients also showed more gastric atrophy, intestinal metaplasia, and gastritis than did patients without H. pylori infection.
Thirty-six patients (2.9%) who were infected with H. pylori at baseline developed gastric cancer, the authors report, versus none of the uninfected patients. Moreover, gastric cancer did not develop in any of the 253 infected patients who had received eradication therapy for their H. pylori infection.
Gastric cancers were significantly more common in patients with nonulcer dyspepsia, gastric ulcers, and gastric polyps than in patients with duodenal ulcers, the report indicates.
"This study substantially bolsters evidence of the association between H. pylori and gastric cancer," declare Dr. James Fox from the Massachusetts Institute of Technology in Cambridge and Dr. Timothy Wang from the University of Massachusetts Medical Center in Worcester declare in a related commentary. But "the question of who should undergo H. pylori eradication remains unresolved," they note.
Dr. Uemura told Reuters Health, "I believe our results support testing of all symptomatic patients for H. pylori infection status. Patients who desire eradication should be treated."
Dr. Uemura is not yet prepared to recommend eradication therapy for cancer prevention, suggesting instead that "trials for the prevention of gastric cancer should be conducted in H. pylori-infected subjects in each country."
N Engl J Med 2001;345:784-789,829-832.
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