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How Can Gastric Cancer Incidence and Mortality Be Reduced?
Helicobacter pylori is a known risk factor for gastric cancer, and its eradication may be protective against the disease. Both garlic and vitamin supplementation may also be protective in populations with nutritional deficiencies.
To ascertain the effects of H. pylori eradication, vitamin supplementation, and garlic supplementation on gastric cancer incidence and mortality, investigators conducted a randomized, placebo-controlled trial involving 3365 people living in China in a high-risk area for gastric cancer. The 2258 participants with H. pylori infection were assigned in a 2×2×2 factorial fashion to H. pylori eradication treatment, supplementation with vitamins (vitamins C, E, and selenium), or supplementation with garlic (extract and oil) or to placebos for each. The 1107 participants without H. pylori infection were assigned in a 2×2 factorial fashion to vitamin or garlic supplementation or to placebos for each.
Results at 22 years of follow-up were as follows:
- H. pylori eradication reduced the incidence of gastric cancer (odds ratio, 0.48) and mortality from gastric cancer (adjusted hazard ratio, 0.62).
- Vitamin supplementation also decreased the incidence of gastric cancer (OR, 0.64) and mortality from gastric cancer (aHR, 0.48).
- Garlic supplementation did not reduce gastric cancer incidence but did reduce mortality from gastric cancer (aHR, 0.66).
- The beneficial effects of both vitamin and garlic supplementation were seen later than those from H. pylori eradication.
Comment
The authors should be congratulated for executing a difficult, randomized, factorial-design study that assessed multiple risk factors and allowed for prolonged follow-up. Although the results reconfirm the benefit of H. pylori eradication at reducing gastric cancer incidence and mortality, the findings of the benefits of vitamin and garlic supplementation required longer observation to become apparent. The generalizability of the findings on supplementation may be limited, given that the study population had baseline nutritional deficiencies and a high risk for gastric cancer, but I would consider recommending a multivitamin for my patients at high risk for gastric cancer.
Citation(s)
Author:
Li W-Q et al.
Title:
Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: Follow-up of a randomized intervention trial.
Source:
BMJ
2019
Sep
11; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
John R. Saltzman, MD