Similarly, two other meta-analyses,(36,37)
which addressed the controversial issue regarding the impact
of H. pylori eradication on gastric atrophy and intestinal
metaplasia, showed significant improvement in gastric atrophy
but not gastric intestinal metaplasia. Thus, gastric intestinal
metaplasia is generally regarded as the point of irreversible
histological change.(36,37) Uemura et al,(38)
who were the first to
provide evidence that H. pylori eradication has a direct impact
on gastric cancer occurrence, conducted a non-randomised H.
pylori eradication trial in patients with early gastric cancer treated
by endoscopic resection. After a three-year follow-up period,
9% of the untreated patients developed metachronous gastric
cancer, while none of the patients who underwent H. pylorieradication developed the disease.(38)
In another prospective
observational study, Uemura et al showed that gastric cancer
developed in persons infected with H. pylori, but not in uninfected
persons.(39)
The pooled data from five randomised placebocontrolled H. pylori eradication trials in Asia(40-44) showed that with
H. pylori eradication, the pooled RR of developing gastric cancer
was 0.56 (95% CI 0.40–0.8).(32) However, it must be recognised
that, prior to eradication, irreversible precancerous lesions may
have already arisen, and in such cases, apart from H. pylori
eradication, a strategy of continued surveillance is required.