Helicobacter pylori eradication and gastric cancer – the evidence is clear!

Review by Prof. Eamonn Quigley (USA)

Study Summary 

Warren and Marshall upended gastrointestinal science and practice when they demonstrated that an infectious agent, Helicobacter pylori (Hp), could cause gastritis, peptic ulcers, and gastric cancer. Decades later, as these clinical entities appear to be on the wane in the West, attitudes to the detection and eradication of Hp may also have changed—testing is less widely applied and treatment and follow-up may not be as robust as they should be. This laxity ignores two important issues:

1. Hp infection remains very common (perhaps, even endemic) in the developing world and among certain populations in the developed world.
2. Hp eradication has the potential to prevent gastric cancer (still a major cause of death in certain populations).

A trio of papers in a recent issue of Gastroenterology provides compelling evidence that Hp eradication is effective in gastric cancer prevention.

Based on a systematic review and meta-analysis of 11 randomized controlled clinical trials and 13 observational studies, Ford and colleagues concluded that eradication lowered the risk of gastric cancer in healthy HP-positive individuals as well as individuals who had undergone endoscopic mucosal resection (EMR) for HP-related gastric neoplasia.¹ Eradication also reduced mortality from gastric cancer among healthy Hp-positive individuals.

Wiklund and colleagues studied over 600,000 adults who had undergone Hp eradication therapy in 5 Nordic countries between 1995 and 2019 and demonstrated a progressive decline in the incidence of gastric cancer over time to reach the level of the background population by 11 years following eradication.²

Jung and colleagues did a similar study in South Korea: they followed over 900,000 individuals who underwent Hp eradication therapy for a mean duration of 12 years and demonstrated a significant reduction in gastric cancer incidence and mortality across all age groups, including those over 70 years of age.³

Commentary 

The study by Ford and colleagues,¹ based on cumulative data from over 80,000 individuals, provides strong support for a test-and-treat approach in asymptomatic individuals. Many of the studies included seem to have been performed among high-risk populations; can these results be extrapolated to the West? Wiklund and colleagues² provide a resounding yes in response to this question. That eradication reduced rates of gastric cancer among individuals who had undergone EMR¹ dismisses concerns that there may be a stage in the progression of Hp-related pathology beyond which eradication will be ineffective. The impressive results from eradication among older subjects in the study from South Korea³ supports efficacy across the spectrum of Hp-elated pathology if one assumes, as seems reasonable, that the infection usually acquired in childhood and that Hp-related inflammation will, progress over time. Most reassuring.

The bottom line: do not miss any opportunity to test and treat regardless of the stage of Hp-related pathology.

Citation

1. Ford AC, Yuan Y, Park JY, Forman D, Moayyedi P. Eradication Therapy to Prevent Gastric Cancer in Helicobacter pylori-Positive Individuals: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Gastroenterology. 2025;169:261-276. 
2. Wiklund AK, Santoni G, Yan J, Radkiewicz C, Xie S, Birgisson H, Ness-Jensen E, von Euler-Chelpin M, Kauppila JH, Lagergren J. Risk of Gastric Adenocarcinoma After Eradication of Helicobacter pylori. Gastroenterology. 2025;169:244-250.
3. Jung YS, Tran MTX, Park B, Moon CM. Preventive Effect of Helicobacter pylori Treatment on Gastric Cancer Incidence and Mortality: A Korean Population Study. Gastroenterology. 2025;169:251-260.

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