How long should patients be surveyed for gastric cancer risk after Helicobacter pylori eradication therapy? 10 years is no longer enough

Excerpt

Helicobacter pylori infection is a major risk factor for the development of gastric cancer, particularly in East Asian populations, including Japan. Gastric cancer is caused by a multifactorial and multistep process mainly related to long-term infection with H. pylori in the gastric mucosa. Nevertheless, eradication treatment for H. pylori infection has also been shown to reduce the risk of gastric cancer in patients with atrophic gastritis, and recent meta-analyses confirmed the same effect in patients after endoscopic and operative resection for gastric cancer [1-3]. The Maastricht V/Florence Consensus Report issued by the European Helicobacter Study Group in 2017 recommended the eradication of H. pylori as first-line treatment in patients with peptic ulcer disease, autoimmune thrombocytopenia, chronic urticaria, iron deficiency anemia, gastric mucosa associated-lymphoid tissue lymphoma, and functional dyspepsia as a means of preventing gastric cancer [4]. For the first time anywhere, the Japanese health insurance system initiated coverage of H. pylori eradication treatment in all patients with endoscopically confirmed H. pylori-associated gastritis in 2012. Against annual gastric cancer death rates of around 50,000 extending back more than 40 years, this expansion of coverage led to a significant decrease in deaths, from 48,427 in 2013 to 45,509 in 2016 [5]. National gastric cancer screening programs with upper endoscopy may have contributed to this decrease by decreasing the risk of diagnosis at an advanced stage, and by H. pylori eradication therapy after endoscopic diagnosis of H. pylori infection [6]. To date, however, most studies investigating the incidence of gastric cancer after eradication therapy have done so over the relatively short period of about 10 years, and it has remained unclear whether the chemopreventive effect of eradication therapy extends beyond 10 years, in consideration of pathological differentiation and the severity of gastric mucosal atrophy. …