1230 Helicobacter pylori Eradication and Its Association With Metachronous Gastric Cancer Recurrence and Pre-Neoplastic Lesions: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Gastric cancer is the 4th leading cause of cancer deaths worldwide displaying global variation in incidence. Helicobacter pylori (H Pylori) is known risk factor for gastric cancer. The magnitude of benefit of H pylori eradication in preventing GC recurrence is unclear. We performed a systematic review (SR) and meta-analysis (MA) of available randomized clinical trials (RCTs) to investigate the impact of H Pylori eradication on GC recurrence and precancerous lesions. METHODS: A planned literature search of Medline, PubMed and Google Scholar databases was carried out from inception to 10 February 2019. Ten (RCTs) included for analysis had H Pylori eradication as intervention arm compared to placebo. Statistical analysis was performed using statistical software RevMan, version 5.3. Random effects model and Mantel-Haenszel method for the statistical analysis was used for dichotomous data to calculate the odds ratio (OR). Two sided P values of less than 0.05 was considered statistically significant. RESULTS: 10 RCTs with total of 7,098 patients were included for final comparison. There were 3548 subjects in H Pylori group and 3550 in the placebo arm. The primary outcome was development of metachronous GC after endoscopic mucosal resection (EMR) in patients with early stage GC. H pylori group showed significant reduction in incidence of metachronous GC compared to placebo OR = 0.47, 95% confidence interval (CI) = 0.33– 0.67, P < 0.0001, I2 = 0%]. Incidence of GC in high risk patients without GC at baseline showed no difference between two groups OR = 0.67, 95% CI = 0.42–1.07, P = 0.09, I2 = 0%). H Pylori eradication group showed statistically significant improvement in AG and IM from baseline compared to placebo group with OR = 2.10, 95% CI = 1.19–3.71, P = 0.01, I2 = 87% and OR = 2.08, 95% CI = 1.28–3.36, P = 0.003, I2 = 30% respectively. RCTs with mean duration of follow up >5 years for GC incidence showed statistically significant reduction in GC incidence in H Pylori eradication group OR = 0.55, 95% CI = 0.40-0.76, P = 0.0003, I2 = 0%. CONCLUSION: Our meta-analysis showed the beneficial role of H Pylori eradication in decreasing GC recurrence for patients with early GC post EMR. H Pylori group also showed improvement in AG and IM grades compared to placebo. There was no difference in GC incidence in asymptomatic patients without GC at baseline between the two groups. More studies are needed from the North America, Europe and other non-Asian countries to better understand the differences in geographical regions.