title: The Clinical Evidence LinkingHelicobacter pylorito Gastric Cancer.
abstract: Gastric cancer has long been recognized to be accompanied and preceded by chronic gastritis, lasting decades. Arguably, the most important development in our understanding of gastric cancer pathogenesis over the past 50 years has been the realization that, for most cases of gastric cancer,Helicobacter pyloriis the cause of the underlying gastritis. Gastritis can promote gastric carcinogenesis, typically via the Correa cascade of atrophic gastritis, intestinal metaplasia, and dysplasia. Nested case-control studies have shown thatH pyloriinfection increases the risk of gastric cancer significantly, both of the intestinal and diffuse subtypes, and thatH pyloriis responsible for approximately 90% of the world's burden of noncardia gastric cancer. Based largely on randomized studies in high gastric cancer prevalence regions in East Asia, it appears that primary and tertiary intervention to eradicateH pylorican halve the risk of gastric cancer. Some public health authorities now are starting screening and treatment programs to reduce the burden of gastric cancer in these high-risk areas. However, there is currently much less enthusiasm for initiating similar attempts in the United States. This is partially because gastric cancer is a relatively less frequent cause of cancer in the United States, and in addition there are concerns about theoretical downsides ofH pylorieradication, principally because of the consistent inverse relationship noted betweenH pyloriand esophageal adenocarcinoma. Nevertheless, establishing a link between chronicH pyloriinfection and gastric cancer has led to novel insights into cancer biology, the gastrointestinal microbiome, and on individual and population-based gastric cancer prevention strategies.
authors.affiliation: Gastroenterology Division, Rhode Island Hospital, Brown University, Providence, Rhode Island.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Moss
keywords: CI, confidence interval; Cancer Prevention; ELISA, enzyme-linked immunosorbent assay; Epidemiology; Gastric Cancer; Helicobacter pylori