Gastroenterology
Volume 137, Issue 5 , Pages 1641-1648.e2, November 2009

Early Helicobacter pylori Eradication Decreases Risk of Gastric Cancer in Patients With Peptic Ulcer Disease

  • Chun–Ying Wu

      Affiliations

    • Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
    • Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
    • Faculty of Medicine, School of Medicine, National Yang–Ming University, Taipei, Taiwan
    • ,
  • Ken N. Kuo

      Affiliations

    • Center for Health Policy Research and Development, National Health Research Institutes; Miaoli, Taiwan
    • ,
  • Ming–Shiang Wu

      Affiliations

    • Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Yi–Ju Chen

      Affiliations

    • Faculty of Medicine, School of Medicine, National Yang–Ming University, Taipei, Taiwan
    • Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
    • ,
  • Chang–Bi Wang

      Affiliations

    • Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
    • ,
  • Jaw–Town Lin

      Affiliations

    • Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
    • Department of Internal Medicine, E–Da Hospital and I–Shou University, Kaohsiung County, Taiwan
    • Corresponding Author InformationReprint requests Jaw–Town Lin, MD, PhD, Department of Internal Medicine, E-Da Hospital and I-Shou University, No. 1, E-Da Rd, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County 824, Taiwan. fax: (88) 6-2-239 47899 or Chun–Ying Wu, MD, MPH, PhD, Division of Gastroenterology, Taichung Veterans General Hospital, 160, Sec. 3, Taichung–Kang Rd, Taichung 407, Taiwan. fax: (88) 6-4-23741331

Received 7 April 2009; accepted 28 July 2009. published online 07 August 2009.

Background & Aims

Helicobacter pylori (H pylori) is a risk factor for gastric cancer. We investigated whether early H pylori eradication is associated with gastric cancer risk in patients with peptic ulcer diseases.

Methods

This nationwide cohort study was based on the Taiwan National Health Insurance Database (NHID), which provided data on 80,255 patients who were hospitalized for the first time between 1997 and 2004 with a primary diagnosis of peptic ulcer diseases and received H pylori eradication therapy. The patient population was divided into early (within 1 year) and late (after 1 year) eradication cohorts; standardized incidence ratios (SIRs) and hazards ratios (HRs) were determined.

Results

There was no significant difference in gastric cancer risk between patients who received early H pylori eradication and the general population (SIR, 1.05; 95% confidence interval [CI]: 0.96–1.14), but late eradication was associated with an increased risk (SIR, 1.36; 95% CI: 1.24–1.49). In gastric ulcer patients who received early eradication, SIRs of gastric cancer decreased from 1.60 at 3–4 years to 1.05 at 7–10 years after hospitalization; the SIRs decreased from 0.57 to 0.33 for duodenal ulcer patients over the same period. Among patients who received late eradication, SIRs decreased from 2.14 to 1.32 for those with gastric ulcers and from 0.90 to 0.66 for those with duodenal ulcers. Early H pylori eradication (HR, 0.77) and frequent aspirin or nonsteroidal anti-inflammatory drug use (HR, 0.65) were independent protective factors for gastric cancer.

Conclusions

Early H pylori eradication is associated with decreased risk of gastric cancer in patients with peptic ulcer diseases.

Abbreviations used in this paper: NHID, National Health Insurance Database, SIRs, standardized incidence ratios

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 This article has an accompanying continuing medical education activity on page 1837. Learning Objective: Upon completion of differentiating the following questions, successful learners will be able to increase their ability in accessing the risk of gastric cancer development and eradicating Helicobacter pylori in patients with peptic ulcer diseases.

 Conflicts of interest The authors disclose no conflicts.

 Funding Supported in part by the National Health Research Institutes grant number: PH-098-PP-26.

PII: S0016-5085(09)01385-7

doi:10.1053/j.gastro.2009.07.060

Gastroenterology
Volume 137, Issue 5 , Pages 1641-1648.e2, November 2009

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