Background and Aims: Helicobacter pylori (H. pylori) eradication in patients with gastric ulcers is known to reduce the risk of gastric cancer. However, the impact of eradication therapy on the occurrence of gastric cancer is not well known in these patients, especially in the elderly. This study aims to assess the incidence of gastric cancer after H. pylori eradication therapy in patients with gastric ulcers in different age groups.
Methods: A nationwide cohort was established using the Korean National Health Insurance Service database. Patients received H. pylori eradication therapy for gastric ulcers. We compared the incidence of gastric cancer in these patients with the Korean general population by estimating a standardized incidence ratio (SIR). Data were analyzed by stratifying age groups (40-49, 50-59, 60-64, 65-69, and ≥70 years old), and by follow-up periods (<5, 5-7, 7-9, 9-11, 11-13, and ≥13 years). Sensitivity analysis was performed by classifying subjects based on the success or failure of H. pylori eradication, using an operational definition.
Results: A total of 212,862 patients with gastric ulcers received H. pylori eradication therapy. During a median follow-up of 10.1 years, 3,419 patients (1.61%) were diagnosed with gastric cancer. The SIR for the patients was 1.20 (95% Confidence Interval [CI], 1.14-1.24). When stratified by age groups, SIRs of the patients were significantly higher than in the general population across all groups. When stratified by the follow-up period groups, it was significantly lower than in the general population with a follow-up period of 13 years or more. (SIR. 0.78; 95% CI, 0.60-0.99) The SIRs for the success and failure groups of eradication therapy were 1.13 (95% CI, 1.07-1.20) and 2.12 (95% CI, 1.57-2.87), respectively. When stratified by age, the SIR in the treatment success group was significantly lower than 1 for the age group 50-59 (SIR, 1.08; 95% CI, 0.97-1.21).
Conclusion: Among patients with gastric ulcers, gastric cancer incidence showed higher than in the general population even after H. pylori eradication therapy. Notably, our study indicates incidence of gastric cancer may be reduced by undergoing H. pylori eradication at the age of less than 60 and decrease after more than 13 years following eradication.

Donghoon Kang

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