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Article: Helicobacter pylori Eradication to Prevent Gastric Cancer in a High-Risk Region of China: A Randomized Controlled Trial

TitleHelicobacter pylori Eradication to Prevent Gastric Cancer in a High-Risk Region of China: A Randomized Controlled Trial
Authors
Issue Date2004
PublisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtl
Citation
Journal Of The American Medical Association, 2004, v. 291 n. 2, p. 187-194 How to Cite?
AbstractContext: Although chronic Helicobacter pylori infection is associated with gastric cancer, the effect of H pylori treatment on prevention of gastric cancer development in chronic carriers is unknown. Objective: To determine whether treatment of H pylori infection reduces the incidence of gastric cancer. Design, Setting, and Participants: Prospective, randomized, placebo-controlled, population-based primary prevention study of 1630 healthy carriers of H pylori infection from Fujian Province, China, recruited in July 1994 and followed up until January 2002. A total of 988 participants did not have precancerous lesions (gastric atrophy, intestinal metaplasia, or gastric dysplasia) on study entry. Intervention: Patients were randomly assigned to receive H pylori eradication treatment: a 2-week course of omeprazole, 20 mg, a combination product of amoxicillin and clavulanate potassium, 750 mg, and metronidazole, 400 mg, all twice daily (n = 817); or placebo (n = 813). Main Outcome Measures: The primary outcome measure was incidence of gastric cancer during follow-up, compared between H pylori eradication and placebo groups. The secondary outcome measure was incidence of gastric cancer in patients with or without precancerous lesions, compared between the 2 groups. Results: Among the 18 new cases of gastric cancers that developed, no overall reduction was observed in participants who received H pylori eradication treatment (n = 7) compared with those who did not (n = 11) (P = .33). In a subgroup of patients with no precancerous lesions on presentation, no patient developed gastric cancer during a follow-up of 7.5 years after H pylori eradication treatment compared with those who received placebo (0 vs 6; P = .02). Smoking (hazard ratio [HR], 6.2; 95% confidence interval [CI], 2.3-16.5; P<.001) and older age (HR, 1. 10; 95% CI, 1.05-1.15; P<.001) were independent risk factors for the development of gastric cancer in this cohort. Conclusions: We found that the incidence of gastric cancer development at the population level was similar between participants receiving H pylori eradication treatment and those receiving placebo during a period of 7.5 years in a high-risk region of China. In the subgroup of H pylori carriers without precancerous lesions, eradication of H pylori significantly decreased the development of gastric cancer. Further studies to investigate the role of H pylori eradication in participants with precancerous lesions are warranted.
Persistent Identifierhttp://hdl.handle.net/10722/87646
ISSN
2014 Impact Factor: 35.289
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWong, BCYen_HK
dc.contributor.authorLam, SKen_HK
dc.contributor.authorWong, WMen_HK
dc.contributor.authorChen, JSen_HK
dc.contributor.authorZheng, TTen_HK
dc.contributor.authorFeng, REen_HK
dc.contributor.authorLai, KCen_HK
dc.contributor.authorHu, WHCen_HK
dc.contributor.authorYuen, STen_HK
dc.contributor.authorLeung, SYen_HK
dc.contributor.authorFong, DYTen_HK
dc.contributor.authorHo, Jen_HK
dc.contributor.authorChing, CKen_HK
dc.contributor.authorChen, JSen_HK
dc.date.accessioned2010-09-06T09:32:31Z-
dc.date.available2010-09-06T09:32:31Z-
dc.date.issued2004en_HK
dc.identifier.citationJournal Of The American Medical Association, 2004, v. 291 n. 2, p. 187-194en_HK
dc.identifier.issn0098-7484en_HK
dc.identifier.urihttp://hdl.handle.net/10722/87646-
dc.description.abstractContext: Although chronic Helicobacter pylori infection is associated with gastric cancer, the effect of H pylori treatment on prevention of gastric cancer development in chronic carriers is unknown. Objective: To determine whether treatment of H pylori infection reduces the incidence of gastric cancer. Design, Setting, and Participants: Prospective, randomized, placebo-controlled, population-based primary prevention study of 1630 healthy carriers of H pylori infection from Fujian Province, China, recruited in July 1994 and followed up until January 2002. A total of 988 participants did not have precancerous lesions (gastric atrophy, intestinal metaplasia, or gastric dysplasia) on study entry. Intervention: Patients were randomly assigned to receive H pylori eradication treatment: a 2-week course of omeprazole, 20 mg, a combination product of amoxicillin and clavulanate potassium, 750 mg, and metronidazole, 400 mg, all twice daily (n = 817); or placebo (n = 813). Main Outcome Measures: The primary outcome measure was incidence of gastric cancer during follow-up, compared between H pylori eradication and placebo groups. The secondary outcome measure was incidence of gastric cancer in patients with or without precancerous lesions, compared between the 2 groups. Results: Among the 18 new cases of gastric cancers that developed, no overall reduction was observed in participants who received H pylori eradication treatment (n = 7) compared with those who did not (n = 11) (P = .33). In a subgroup of patients with no precancerous lesions on presentation, no patient developed gastric cancer during a follow-up of 7.5 years after H pylori eradication treatment compared with those who received placebo (0 vs 6; P = .02). Smoking (hazard ratio [HR], 6.2; 95% confidence interval [CI], 2.3-16.5; P<.001) and older age (HR, 1. 10; 95% CI, 1.05-1.15; P<.001) were independent risk factors for the development of gastric cancer in this cohort. Conclusions: We found that the incidence of gastric cancer development at the population level was similar between participants receiving H pylori eradication treatment and those receiving placebo during a period of 7.5 years in a high-risk region of China. In the subgroup of H pylori carriers without precancerous lesions, eradication of H pylori significantly decreased the development of gastric cancer. Further studies to investigate the role of H pylori eradication in participants with precancerous lesions are warranted.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtlen_HK
dc.relation.ispartofJournal of the American Medical Associationen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAmoxicillin-Potassium Clavulanate Combination - therapeutic useen_HK
dc.subject.meshAnti-Infective Agents - therapeutic useen_HK
dc.subject.meshAnti-Ulcer Agents - therapeutic useen_HK
dc.subject.meshChina - epidemiologyen_HK
dc.subject.meshDrug Therapy, Combinationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHelicobacter Infections - complications - drug therapy - pathologyen_HK
dc.subject.meshHelicobacter pylorien_HK
dc.subject.meshHumansen_HK
dc.subject.meshIncidenceen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMetronidazole - therapeutic useen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshOmeprazole - therapeutic useen_HK
dc.subject.meshPrecancerous Conditions - epidemiology - microbiology - pathology - prevention & controlen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshRisk Factorsen_HK
dc.subject.meshStomach Neoplasms - epidemiology - microbiology - pathology - prevention & controlen_HK
dc.titleHelicobacter pylori Eradication to Prevent Gastric Cancer in a High-Risk Region of China: A Randomized Controlled Trialen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0098-7484&volume=291&issue=2&spage=187&epage=194&date=2004&atitle=Helicobacter+pylori+Eradication+to+Prevent+Gastric+Cancer+in+a+High-Risk+Region+of+China:+a+Randomized+Controlled+Trialen_HK
dc.identifier.emailWong, BCY: bcywong@hku.hken_HK
dc.identifier.emailLeung, SY: suetyi@hku.hken_HK
dc.identifier.emailFong, DYT: dytfong@hku.hken_HK
dc.identifier.authorityWong, BCY=rp00429en_HK
dc.identifier.authorityLeung, SY=rp00359en_HK
dc.identifier.authorityFong, DYT=rp00253en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1001/jama.291.2.187en_HK
dc.identifier.pmid14722144en_HK
dc.identifier.scopuseid_2-s2.0-9144220789en_HK
dc.identifier.hkuros86750en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-9144220789&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume291en_HK
dc.identifier.issue2en_HK
dc.identifier.spage187en_HK
dc.identifier.epage194en_HK
dc.identifier.isiWOS:000188040900026-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridWong, BCY=7402023340en_HK
dc.identifier.scopusauthoridLam, SK=7402279800en_HK
dc.identifier.scopusauthoridWong, WM=7403972413en_HK
dc.identifier.scopusauthoridChen, JS=8403980500en_HK
dc.identifier.scopusauthoridZheng, TT=7201358325en_HK
dc.identifier.scopusauthoridFeng, RE=36720622500en_HK
dc.identifier.scopusauthoridLai, KC=7402135595en_HK
dc.identifier.scopusauthoridHu, WHC=7404359791en_HK
dc.identifier.scopusauthoridYuen, ST=7103160927en_HK
dc.identifier.scopusauthoridLeung, SY=7202044886en_HK
dc.identifier.scopusauthoridFong, DYT=35261710300en_HK
dc.identifier.scopusauthoridHo, J=55166750600en_HK
dc.identifier.scopusauthoridChing, CK=7102130825en_HK
dc.identifier.scopusauthoridChen, JS=8433879700en_HK

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