Helicobacter pylori eradication treatment

Research Summary & Abstract: BACKGROUND: Chronic atrophic gastritis (CAG) is widely recognized as one of the precancerous lesions of gastric cancer. Helicobacter pylori is one of the important risk factors for CAG and gastric cancer. However, a large proportion of patients with CAG cannot avoid developing gastric cancer even after eradicating H pylori. It is necessary to find a safe and effective treatment to suppress this "inflammation-cancer" progression. The Qi-Lian-Xiao-Pi prescription (WW-1), a traditional Chinese medicine (TCM), has been reported to be effective in the treatment of CAG. However, the evidence is subject to methodological limitations. OBJECTIVE: This study aimed to evaluate the efficacy, safety, and mechanism of the WW-1 in patients with CAG following successful H pylori eradication. METHODS: This study is a rigorous parallel-arm, randomized, placebo-controlled, multicenter, double-blinded trial. A total of 110 eligible participants with a confirmed diagnosis of CAG after H pylori eradication are being enrolled and randomly assigned in a 1:1 ratio to either the intervention group (WW-1) or the control group (WW-1 placebo). Key eligibility criteria include confirmed CAG by histopathology, documented successful H pylori eradication, and compliance with predefined inclusion and exclusion criteria. The treatment duration is 24 weeks. Blinded histopathological assessments using the Operative Link on Gastritis Assessment and Operative Link on Gastric Intestinal Metaplasia Assessment staging systems will serve as primary outcomes. Secondary outcomes include improvement rates of gastric mucosal gland atrophy and intestinal metaplasia, as well as TCM syndrome scores. Safety will be assessed through monitoring vital signs, adverse events, blood, urine, and stool tests, liver and kidney function, and electrocardiography. Additionally, gastric mucosal DNA methylation and metagenomic sequencing of digestive tract microbiota (including saliva, tongue coating, gastric, and intestinal samples) will be analyzed to explore potential mechanisms of WW-1. RESULTS: The funding began in November 2023. The study was officially initiated on April 20, 2025, with the enrollment of the first participant. The final study results, including efficacy outcomes, safety profiles, and mechanistic insights, are expected to be released in October 2026 after comprehensive data analysis and verification. CONCLUSIONS: This study is designed to determine whether WW-1 can improve CAG by modulating gastric mucosal DNA methylation and the digestive tract microbiota. It represents a prospective clinical trial in TCM that aims to evaluate therapeutic effects on CAG through the regulation of microbiota homeostasis and epigenetic mechanisms. The findings of this study are expected to provide evidence regarding the efficacy and safety of WW-1 and contribute to the development of therapeutic strategies and future drug research for CAG. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/90965.

Research Summary & Abstract: Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin are the most frequently prescribed drugs worldwide, and their long-term use often leads to peptic ulcers (PUs) along with serious complications, such as bleeding and perforation. Helicobacter pylori (H. pylori) infection is a significant risk factor for developing NSAID-related PU and ulcer bleeding during long-term aspirin use. In a revised version of the Clinical Guidelines for Drug-induced Peptic Ulcer, two statements regarding H. pylori eradication are recommended. 1) Patients scheduled for long-term NSAID therapy should be tested and treated for H. pylori infection to prevent PU and its complications. 2) Patients with a history of PU receiving long-term low-dose aspirin (LDA) therapy should undergo treatment for H. pylori infection to prevent PU and its complications. On the other hand, unlike NSAID-naïve patients, the preventive effects of H. pylori eradication in chronic NSAID users are unclear. In addition, anti-ulcer drugs, such as proton pump inhibitors, may be necessary for maintenance therapy after H. pylori eradication in a subset of long-term LDA users, particularly if the patients are taking concomitant antiplatelet agents or anticoagulants.

Research Summary & Abstract: Gastric cancer remains one of the leading causes of cancer mortality worldwide, characterized by marked geographic disparities that cannot be fully explained by the distribution of Helicobacter pylori infection alone. Although H. pylori is recognized as the principal etiological agent, reductionist models centered exclusively on infection prevalence and eradication fail to account for the complex heterogeneity of gastric cancer risk across populations. In this narrative review, we propose a multiscale ecological framework that integrates infectious, host, environmental, microbial, and socioeconomic determinants to reinterpret gastric carcinogenesis as an emergent phenomenon arising from dynamic interactions across biological and geographic scales. Drawing on current epidemiological, molecular, and systems biology evidence, we examine how H. pylori interacts with host genetic susceptibility, epigenetic alterations, microbial community dynamics, dietary exposures, environmental modifiers, and structural social determinants to shape the trajectory of the Correa precancerous cascade. This integrative perspective helps explain key epidemiological paradoxes, including the persistence of high gastric cancer incidence in regions with comparable infection prevalence and the incomplete risk reduction observed after bacterial eradication in advanced mucosal injury. We further highlight the concept of persistent molecular and microenvironmental "carcinogenic memory," whereby epigenetic alterations and dysbiotic microecological states sustain oncogenic potential even after elimination of the infectious agent. By framing gastric carcinogenesis as a complex ecological process rather than a pathogen-driven event, this model bridges mechanistic insights with population-level patterns and provides a conceptual platform for more effective prevention strategies. Ultimately, this framework supports a shift toward integrated approaches that combine early detection, targeted eradication, environmental modification, microbiome-aware strategies, and equitable health policies to reduce the global burden of gastric cancer.

Research Summary & Abstract: Background The rate of gastric cancer(GC) has reduced globally in all ages in recent years, but some data has started to emerge of a reversal in those >50 years, particularly in wealthier countries. H. pylori(HP) infection is associated with 89% of GC diagnoses, and its eradication is associated with a clear risk-reduction. The approach to diagnosis varies globally, however recently IARC haas reccommended screening in all populations. Summary A test-and-treat approach towards symptomatic young people is advocated among European populations, and has been shown to improve dyspepsia and reduce costs. Its impact on GC rates are less clear. Studies in high-incidence countries have demonstrated cost-effective, real-world reductions in GC rates with population-based HP screening(screen-and-treat). Abundant modelling data in these countries show economic benefits to nearly all screening programs, however, data in European populations, at lower risk, is lacking. Modelled data suggests it may be feasible, but currently no guidelines recommend a specific approach. Prospective European studies are underway to assess the feasibility of various screening methods. We discuss the evidence behind both approaches and the use of both endoscopy(Test-scope-and-treat) and biomarkers as adjuncts to population-based screening to maximise gastric cancer reduction from any future European screening programme. Key Messages Prospective data from H. pylori high-incidence countries have shown a clear cost-effective reduction in gastric cancer diagnoses after introduction of population-screening. Modelled data from H. pylori low-incidence countries shows population-based screening may be cost effective, but real-world feasibility data is lacking.

Research Summary & Abstract: Gastric cancer is the most common cancer in Korea and the fifth most common cancer globally. Helicobacter pylori (H. pylori) infection is considered the main etiologic agent for gastric cancer development. Most regional guidelines for H. pylori treatment recommend treating the organism to prevent gastric cancer in the high-risk group. However, evidence that such a strategy can also be applied to the general population, especially in terms of the preventive effect and safety, has not been adequately presented yet. Although a meta-analysis in the general population suggested effectiveness in decreasing gastric cancer incidence, individual studies should be critically reviewed to evaluate the soundness of the evidence. Recently published, long-term, Korean studies on metachronous gastric cancer prevention ended the controversies from previous short-term studies and confirmed the effectiveness. Currently, further prospective, large, randomized studies are ongoing in the general population and will provide more definitive, high-level evidence on this gastric cancer prevention strategy in the next decade.