R3 김재민 / Prof. 장영운 Journal conference 1

Helicobacter pylori : causative bacterium for gastric cancer The possible prophylactic effect of H. pylori eradication on the development of gastric cancer ? randomized controlled study in Japan (2008) : eradication therapy reduced the risk of developing metachronous gastric cancer after EMR of early gastric cancer INTRODUCTION INTRODUCTION 2

However, in people with H. pylori infection in whom the cancer is not yet established, a meta-analysis of randomized controlled trials failed to show a significant prophylactic effect of eradication therapy Recently, analysis of extended follow-up of the original RCT which was included in the meta-analysis, : significant reduction of gastric cancer incidence 14.7 years after the eradication therapy INTRODUCTION INTRODUCTION 3

We showed : eradication of H. pylori in patients with peptic ulcer disease reduced their risk of developing gastric cancer one-third after a f/u period as long as 8.6 years (mean, 3.4 years) We have now followed our cohort for as long as 17.4 years INTRODUCTION INTRODUCTION 4

PATIENTS and METHODS PATIENTS and METHODS patients (152 women and 1190 men) with PUD, received H.pylori eradication therapy mean age : 50 years (17~83 years) ~ underwent endoscopy at enrollment to evaluate PUD 776 had GU, 495 had DU, 71 had both Excluded previous gastrectomy or EMR for gastric neoplasm pregnant allergic to penicillin, clarithromycin, or metronidazole taking anticoagulants

Eradication therapy and Eradication therapy and Post-eradication schedule Post-eradication schedule 6 H. pylori infection : culture(+) from endoscopic biopsy specimens Eradication therapy : PPI + amoxicillin or PPI + 2 of 3(amoxicillin, clarithromycin, or metronidazole) 1~2 months after completion of therapy : 13 C-urea breath test and endoscopy cure : culture(-) & rapid urease test(-) & UBT(-) endoscopy and UBT, yearly f/u until 2008

7 RESULTS RESULTS 21/1,030 Fail to 1 year f/u Total 1,222 f/u /1,2229/192 Fail to 1 year f/u

8 RESULTS RESULTS > > <

9

10 Retreatment & cured 포함

11 RESULTS RESULTS

CONCLUSIONS CONCLUSIONS A prophylactic effect for gastric cancer persists for more than 10 years after H.pylori eradication therapy, but we should be aware that cancer can develop even after that interval. 12