title: Asia-Pacific consensus guidelines on gastric cancer prevention.
abstract: 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.
authors.affiliation: Changi General Hospital, Singapore. kwong_ming_fock@cgh.com.sg
authors.forename: Kwong Ming
authors.initials: KM
authors.lastname: Fock
authors.forename: Nick
authors.initials: N
authors.lastname: Talley
authors.forename: Paul
authors.initials: P
authors.lastname: Moayyedi
authors.forename: Richard
authors.initials: R
authors.lastname: Hunt
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.forename: Shu Dong
authors.initials: SD
authors.lastname: Xiao
authors.forename: Shiu Kum
authors.initials: SK
authors.lastname: Lam
authors.forename: Khean Lee
authors.initials: KL
authors.lastname: Goh
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
authors.forename: Jae G
authors.initials: JG
authors.lastname: Kim
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
authors.forename: Hazel
authors.initials: H
authors.lastname: Mitchell
authors.forename: Abdul Aziz
authors.initials: AA
authors.lastname: Rani
authors.forename: Jyh Ming
authors.initials: JM
authors.lastname: Liou
authors.forename: Ratha-Korn
authors.initials: RK
authors.lastname: Vilaichone
authors.forename: Jose
authors.initials: J
authors.lastname: Sollano
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D016588:Anticarcinogenic Agents; D014408:Biomarkers, Tumor; D010435:Pepsinogens; D017673:Sodium Chloride, Dietary; D014815:Vitamins; D001205:Ascorbic Acid