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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: https://doi.org/10.1136/bmj.g3174 (Published 20 May 2014) Cite this as: BMJ 2014;348:g3174

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

The present systematic review and meta-analysis findings suggest that searching for and eradicating H.pylori may reduce the incidence of gastric cancer in healthy asymptomatic infected individuals despite a wide 95% confidence intervals and based heavily on the findings of one study in the review. This finding can also be interpreted in other way as well. Since the other studies do not show ample evidence, why should the findings of one study be given undue importance ? In fact, the diversity of the treatment regimes used in different studies with varying degrees of efficacy against H. pylori infection cast a doubt on the generalizability on the effectiveness of eradication of the infection and hence in the prevention of the incidence of gastric cancers.

The study should have given some more additional information on the role of other risk factors which might have been present in the populations studied other than H.pylori. There are several risk factors for gastric cancer such as alcohol intake, smoking, use of tobacco products, diets that have large amounts of smoked foods, salted fish and meat, and pickled vegetables, males, older age, family history, obesity, previous history of peptic ulcers, previous stomach surgery, occupations such as workers in the coal, metal, and rubber industries, Epstein Barr virus infection, blood group A etc. It would be prudent to understand that whether the chosen studies have discussed these factors as well to rule out the confounders and bias. We also need to consider ‘Protopathic bias”, whether H.pylori infection occurred before the occurrence of pre-malignant lesions or after the development of pre-malignant lesions. This aspect might be difficult to ascertain from the reported studies unless their data is analyzed. Additionally, there might have been interventions in the form behavior change communication to those who are at risk and the possible effect of these interventions on the study outcomes should have been discussed. The presence of such interventions should have been discussed. In view of these possibilities, the current systematic review and meta-analysis findings should be taken cautiously and it may not give a true picture on the relationship between H.pylori infection and gastric cancer.

Competing interests: No competing interests

07 June 2014
Mongjam Meghachandra Singh
Professor,
Reeta Devi, Niharika Yedla
Maulana Azad Medical College, New Delhi; co-author- Indira Gandhi National Open University, New Delhi
Department of Community Medicine, Maulana Azad Medical College, New Delhi, India. Co-author : School of Health Sciences, IGNOU, New Delhi (India)