Résumé :
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[BDSP. Notice produite par INIST-CNRS bR0xq0Z2. Diffusion soumise à autorisation]. Context : Although chronic Helicobacter pylori infection is associated with gastric cancer, the effect of H pylori treatment on prevention of gastric cancer development in chronic carriers is unknown. Objective : To determine whether treatment of H pylori infection reduces the incidence of gastric cancer. Design, Setting, and Participants : Prospective, randomized, placebo-controlled, population-based primary prevention study of 1630 healthy carriers of H pylori infection from Fujian Province, China, recruited in July 1994 and followed up until January 2002. A total of 988 participants did not have precancerous lesions (gastric atrophy, intestinal metaplasia, or gastric dysplasia) on study entry. Intervention Patients were randomly assigned to receive H pylori eradication treatment : a 2-week course of omeprazole, 20 mg, a combination product of amoxicillin and clavulanate potassium, 750 mg, and metronidazole, 400 mg, all twice daily (n=817) ; or placebo (n=813). Main Outcome Measures : The primary outcome measure was incidence of gastric cancer during follow-up, compared between H pylori eradication and placebo groups. The secondary outcome measure was incidence of gastric cancer in patients with or without precancerous lesions, compared between the 2 groups. Results Among the 18 new cases of gastric cancers that developed, no overall reduction was observed in participants who received H pylori eradication treatment (n=7) compared with those who did not (n=11) (P=33). In a subgroup of patients with no precancerous lesions on presentation, no patient developed gastric cancer during a follow-up of 7.5 years after H pylori eradication treatment compared with those who received placebo (0 vs 6 ; P=02). Smoking (hazard ratio [HR], 6.2 ; 95% confidence interval [Cl], 2.3-16.5 ; P<. and older age cl p were independent risk factors for the development of gastric cancer in this cohort. conclusions : we found that incidence at population level was similar between participants receiving h pylori eradication treatment those placebo during a period years high-risk region china. subgroup carriers without precancerous lesions significantly decreased cancer. further studies to investigate role with are warranted.>
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