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Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials

BMJ 2014; 348 doi: (Published 20 May 2014) Cite this as: BMJ 2014;348:g3174
  1. Alexander C Ford, associate professor and honorary consultant gastroenterologist12,
  2. David Forman, head of section3,
  3. Richard H Hunt, professor of gastroenterology4,
  4. Yuhong Yuan, research associate4,
  5. Paul Moayyedi, director of Gastroenterology Division4
  1. 1Leeds Gastroenterology Institute, St James’s University Hospital, Leeds LS9 7TF, UK
  2. 2Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
  3. 3Cancer Information Section, International Agency for Research on Cancer, Lyon, France
  4. 4Farncombe Family Digestive Health Research Institute, Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
  1. Correspondence to: A C Ford alexf12399{at}
  • Accepted 30 April 2014


Objectives To determine whether searching for Helicobacter pylori and treating with eradication therapy leads to a reduction in incidence of gastric cancer among healthy asymptomatic infected individuals.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Medline, Embase, and the Cochrane central register of controlled trials were searched through to December 2013. Conference proceedings between 2001 and 2013 were hand searched. A recursive search was performed with bibliographies of relevant studies. There were no language restrictions.

Eligibility criteria for selecting studies Randomised controlled trials examining the effect of at least seven days of eradication therapy on subsequent occurrence of gastric cancer in adults who tested positive for Helicobacter pylori but otherwise healthy and asymptomatic were eligible. The control arm had to receive placebo or no treatment. Subjects had to be followed for ≥2 years.

Main outcome measures Primary outcome, defined a priori, was the effect of eradication therapy on the subsequent occurrence of gastric cancer expressed as a relative risk of gastric cancer with 95% confidence intervals.

Results The search strategy identified 1560 citations, of which six individual randomised controlled trials were eligible. Fifty one (1.6%) gastric cancers occurred among 3294 individuals who received eradication therapy versus 76 (2.4%) in 3203 control subjects (relative risk 0.66, 95% confidence interval 0.46 to 0.95), with no heterogeneity between studies (I2=0%, P=0.60). If the benefit of eradication therapy was assumed to persist lifelong the number needed to treat was as low as 15 for Chinese men and as high as 245 for US women.

Conclusions These data provide limited, moderate quality evidence that searching for and eradicating H pylori reduces the incidence of gastric cancer in healthy asymptomatic infected Asian individuals, but these data cannot necessarily be extrapolated to other populations.


  • Contributors: All authors conceived and drafted the study, and analysed and interpreted the data. ACF drafted the manuscript, and all authors approved the final draft of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding: None.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that they have no relationships with companies that might have an interest in the submitted work in the previous 3 years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and they have no non-financial interests that may be relevant to the submitted work.”

  • Data sharing: No additional data available.

  • Transparency: ACF (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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