Does eradication of Helicobacter pylori increase risk of esophageal adenocarcinoma?
Review by Prof. Eamonn Quigley (USA)
Study Summary
Not long after regimens for the successful eradication of Helicobacter pylori (Hp) were described and widely implemented, concerns arose surrounding the possibility that eradication by reversing gastritis and restoring gastric acid secretion could promote gastro-esophageal reflux disease (GERD) and, ultimately, its most feared consequence – adenocarcinoma of the esophagus. In other words, could the eradicated patient be exchanging protection from one form cancer with increased risk for another?
This population-based study from the Nordic countries set out to provide a definitive answer. 661,987 adults who received Hp treatment between 1995 and 2018 were followed for a median duration of 7.8 years and their outcomes compared to those of the entire Nordic population. They found that the overall standardized incidence rate for esophageal adenocarcinoma was not increased (0.89) and, furthermore, seemed to decrease with time being 0.73 among those followed for 11-24 years. In contrast, GERD and long-term proton pump inhibitor therapy were associated with increased risk for esophageal adenocarcinoma. There were no associations with squamous cancer of the esophagus.
Commentary
These findings will lead to a great sigh of relief among all who treat Helicobacter pylori infections. Their conclusions are strengthened by the simultaneous failure to associate eradication with any trends in the incidence of squamous cancer and their description of the expected association of adenocarcinoma with GERD. As stressed by the authors, their findings are not the absolute final word – longer-term follow up of even larger patient numbers will, in time, provide this.
Citation
Wiklund A-K, Santoni G, Yan J, et al. Risk of esophageal adenocarcinoma after Helicobacter pylori eradication in a population-based multinational cohort study. Gastroenterology 2024;167:485-92.
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