Long-Term Risk of Gastric Cancer After Helicobacter pylori Eradication in Gastric Ulcer Patients: A Nationwide Cohort Study in Korea

Abstract

Background

Helicobacter pylori eradication reduces gastric cancer risk, but the long-term impact in peptic ulcer patients, particularly those with gastric ulcers (GU), remains unclear.

Aims

To assess the long-term incidence of gastric cancer in patients with H. pylori-treated gastric ulcers compared to the general population and to patients with duodenal ulcers (DU).

Methods

Using Korea's National Health Insurance Service database, we identified patients aged ≥ 40 years with endoscopically and histologically confirmed peptic ulcers treated for H. pylori between 2005 and 2008. Follow-up continued until 2019. Standardized incidence ratios (SIRs) for gastric cancer were calculated by comparing incidence in the study cohorts with the age- and sex-matched general population.

Results

Among 166,260 eligible patients (median follow-up 9.2 years), 2630 (1.58%) developed gastric cancer (SIR, 1.20; 95% CI, 1.15–1.24; p < 0.001), with consistently elevated risks across all age groups. Although cancer incidence remained elevated up to 12 years, patients followed for ≥ 13 years exhibited a significantly reduced risk compared to the general population (SIR, 0.78; 95% CI, 0.60–0.99; p = 0.049). In a sensitivity analysis, duodenal ulcer patients (n = 46,602) showed a lower overall risk (SIR, 0.86; 95% CI, 0.78–0.94; p < 0.001), with significant reductions even before 13 years of follow-up.

Conclusions

Gastric ulcer patients remain at increased risk for gastric cancer following H. pylori treatment. However, this risk declines over time and may fall below that of the general population after 13 years. These findings support the need for long-term surveillance in this high-risk group.