Evaluation of the epidemiological efficacy of eradicating Helicobacter pylori on development of gastric cancer.

Eradication of Helicobacter pylori (H. pylori) colonization has been reported to affect the progression of gastric cancer. A comprehensive literature search was performed from 1997 to 2017 through the electronic database. All randomized controlled trials (RCT) and non-randomized controlled trials (non-RCT) evaluated the effect of H. pylori eradication on development of gastric cancer. Four RCTs and nine non-RCTs were included, with a total of 40,740 participants (321,269 person-years). Overall, H. pylori eradication therapy was associated with a significantly reduced the risk of gastric cancer (Incidence rate ratio, IRR = 0.52, 95% CI: 0.41, 0.65). Results of mixed-effect Poisson regression meta-analysis were similar with traditional meta-analyses. In stratified analyses, the IRRs were 0.59 (95% CI: 0.41, 0.86) in RCTs and 0.48 (95% CI: 0.36, 0.64) in non-RCTs. The IRRs were 0.45 (95% CI: 0.34, 0.61) in patients and 0.63 (95% CI: 0.44, 0.90) in population. Moreover, the relative risk reduction was approximately 77% on the development of non-cardiac gastric cancer for H. pylori eradication therapy in China. Attributable risk percentage and population attributable risk percentage for Chinese patients were 77.08% and 75.33% and Japanese patients were 57.80% and 45.99%. In conclusion, H. pylori eradication therapy reduces the risk of developing non-cardiac gastric cancer, the findings indicate the importance of early intervention of H. pylori eradication therapy from the perspective of epidemiology.