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Article: Helicobacter pylori Eradication to Prevent Gastric Cancer in a High-Risk Region of China: A Randomized Controlled Trial
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TitleHelicobacter pylori Eradication to Prevent Gastric Cancer in a High-Risk Region of China: A Randomized Controlled Trial
 
AuthorsWong, BCY1
Lam, SK1
Wong, WM1
Chen, JS3
Zheng, TT1
Feng, RE1
Lai, KC1
Hu, WHC1
Yuen, ST1
Leung, SY1
Fong, DYT1
Ho, J1
Ching, CK1
Chen, JS2
 
Issue Date2004
 
PublisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtl
 
CitationJournal Of The American Medical Association, 2004, v. 291 n. 2, p. 187-194 [How to Cite?]
DOI: http://dx.doi.org/10.1001/jama.291.2.187
 
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.
 
ISSN0098-7484
2012 Impact Factor: 29.978
2012 SCImago Journal Rankings: 4.843
 
DOIhttp://dx.doi.org/10.1001/jama.291.2.187
 
ISI Accession Number IDWOS:000188040900026
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorWong, BCY
 
dc.contributor.authorLam, SK
 
dc.contributor.authorWong, WM
 
dc.contributor.authorChen, JS
 
dc.contributor.authorZheng, TT
 
dc.contributor.authorFeng, RE
 
dc.contributor.authorLai, KC
 
dc.contributor.authorHu, WHC
 
dc.contributor.authorYuen, ST
 
dc.contributor.authorLeung, SY
 
dc.contributor.authorFong, DYT
 
dc.contributor.authorHo, J
 
dc.contributor.authorChing, CK
 
dc.contributor.authorChen, JS
 
dc.date.accessioned2010-09-06T09:32:31Z
 
dc.date.available2010-09-06T09:32:31Z
 
dc.date.issued2004
 
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.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationJournal Of The American Medical Association, 2004, v. 291 n. 2, p. 187-194 [How to Cite?]
DOI: http://dx.doi.org/10.1001/jama.291.2.187
 
dc.identifier.doihttp://dx.doi.org/10.1001/jama.291.2.187
 
dc.identifier.epage194
 
dc.identifier.hkuros86750
 
dc.identifier.isiWOS:000188040900026
 
dc.identifier.issn0098-7484
2012 Impact Factor: 29.978
2012 SCImago Journal Rankings: 4.843
 
dc.identifier.issue2
 
dc.identifier.openurl
 
dc.identifier.pmid14722144
 
dc.identifier.scopuseid_2-s2.0-9144220789
 
dc.identifier.spage187
 
dc.identifier.urihttp://hdl.handle.net/10722/87646
 
dc.identifier.volume291
 
dc.languageeng
 
dc.publisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtl
 
dc.publisher.placeUnited States
 
dc.relation.ispartofJournal of the American Medical Association
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAdult
 
dc.subject.meshAmoxicillin-Potassium Clavulanate Combination - therapeutic use
 
dc.subject.meshAnti-Infective Agents - therapeutic use
 
dc.subject.meshAnti-Ulcer Agents - therapeutic use
 
dc.subject.meshChina - epidemiology
 
dc.subject.meshDrug Therapy, Combination
 
dc.subject.meshFemale
 
dc.subject.meshHelicobacter Infections - complications - drug therapy - pathology
 
dc.subject.meshHelicobacter pylori
 
dc.subject.meshHumans
 
dc.subject.meshIncidence
 
dc.subject.meshMale
 
dc.subject.meshMetronidazole - therapeutic use
 
dc.subject.meshMiddle Aged
 
dc.subject.meshOmeprazole - therapeutic use
 
dc.subject.meshPrecancerous Conditions - epidemiology - microbiology - pathology - prevention & control
 
dc.subject.meshProspective Studies
 
dc.subject.meshRisk Factors
 
dc.subject.meshStomach Neoplasms - epidemiology - microbiology - pathology - prevention & control
 
dc.titleHelicobacter pylori Eradication to Prevent Gastric Cancer in a High-Risk Region of China: A Randomized Controlled Trial
 
dc.typeArticle
 
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<contributor.author>Lai, KC</contributor.author>
<contributor.author>Hu, WHC</contributor.author>
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<contributor.author>Leung, SY</contributor.author>
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Author Affiliations
  1. The University of Hong Kong
  2. Chinese Center for Disease Control and Prevention
  3. Changle Inst. for Cancer Research