Asia-Pacific consensus guidelines on gastric cancer prevention.
OBJECTIVE
Gastric cancer is a major health burden in the Asia-Pacific region but consensus on prevention strategies has been lacking. We aimed to critically evaluate strategies for preventing gastric cancer.


METHODS
A multidisciplinary group developed consensus statements using a Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded.


RESULTS
Helicobacter pylori infection is a necessary but not sufficient causal factor for non-cardia gastric adenocarcinoma. A high intake of salt is strongly associated with gastric cancer. Fresh fruits and vegetables are protective but the use of vitamins and other dietary supplements does not prevent gastric cancer. Host-bacterial interaction in H. pylori infection results in different patterns of gastritis and differences in gastric acid secretion which determine disease outcome. A positive family history of gastric cancer is an important risk factor. Low serum pepsinogens reflect gastric atrophy and may be useful as a marker to identify populations at high risk for gastric cancer. H. pylori screening and treatment is a recommended gastric cancer risk reduction strategy in high-risk populations. H. pylori screening and treatment is most effective before atrophic gastritis has developed. It does not exclude the existing practice of gastric cancer surveillance in high-risk populations. In populations at low risk for gastric cancer, H. pylori screening is not recommended. First-line treatment of H. pylori infection should be in accordance with national treatment guidelines.


CONCLUSIONS
A strategy of H. pylori screening and eradication in high-risk populations will probably reduce gastric cancer incidence, and based on current evidence is recommended by consensus.
Fock
Kwong Ming
KM
Changi General Hospital, Singapore. kwong_ming_fock@cgh.com.sg
Talley
Nick
N
Moayyedi
Paul
P
Hunt
Richard
R
Azuma
Takeshi
T
Sugano
Kentaro
K
Xiao
Shu Dong
SD
Lam
Shiu Kum
SK
Goh
Khean Lee
KL
Chiba
Tsutomu
T
Uemura
Naomi
N
Kim
Jae G
JG
Kim
Nayoung
N
Ang
Tiing Leong
TL
Mahachai
Varocha
V
Mitchell
Hazel
H
Rani
Abdul Aziz
AA
Liou
Jyh Ming
JM
Vilaichone
Ratha-Korn
RK
Sollano
Jose
J
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D014408:Biomarkers, Tumor / Q000032:analysis*; D019587:Dietary Supplements; D019317:Evidence-Based Medicine; D005638:Fruit; D020022:Genetic Predisposition to Disease; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000235:genetics; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods; D010139:Pacific Islands / Q000453:epidemiology; D010375:Pedigree; D010435:Pepsinogens / Q000032:analysis; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D017673:Sodium Chloride, Dietary / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014675:Vegetables; D014815:Vitamins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D016588:Anticarcinogenic Agents; D014408:Biomarkers, Tumor; D010435:Pepsinogens; D017673:Sodium Chloride, Dietary; D014815:Vitamins; D001205:Ascorbic Acid