Antibiotics please.

Top Line: Patients with early stage (pT1N0) gastric cancer are eligible for organ preservation. That’s great, except for the part about being at high risk for future gastric cancers.
The Study: Helicobacter pylori eradication works to reduce gastric cancers in Mongolian gerbils so how about in South Korean humans? A large phase 3 trial enrolled 470 patients with early stage gastric cancer or high grade adenoma with concurrent H. pylori infections. 396 patients went on to receive endoscopic resection alone and were eligible for analysis. Post-resection, all patients received a proton pump inhibitor for 5 weeks +/- antibiotic therapy with amoxicillin (1000 mg) and clarithromycin (500 mg) twice daily for one week. Everyone then got follow-up endoscopic biopsy samplings at 3 and 36 months. The first primary endpoint was rate of subsequent gastric cancers, and those were 7% with antibiotics and 13% without (p=0.03) at a median follow-up of 6 years. The second primary endpoint was improvement in glandular atrophy at 3 years, and those rates were 48% with antibiotics and 15% without (p<0.0001).
Bottom Line: In patients eligible for endoscopic resection of precancerous or early stage gastric cancer with concurrent H. pylori infections, just one week of antibiotics can cut their risk of future gastric cancer in half. | Choi, N Engl J Med 2018


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