Helicobacter pylori as a risk factor for gastric cancer: the evidence and primary prevention strategy

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Abstract

Russia is a country with a high prevalence of Helicobacter pylori (HP) infection, a high incidence of gastric cancer, and its late diagnosis. HР infection has been recognized as the leading manageable risk factor for gastric cancer. Accurate diagnostic tests must be used to identify and control the effectiveness of HP eradication, and effective schemes must be implemented for HP eradication. The aim of this article was to analyze the latest consensus documents, systematic reviews and meta-analyzes that reflected the role of HP as a risk factor for the development of gastric cancer, as well as measures for the risk reduction. We describe in detail the diagnostic methods for HP infection, provide data on their use in the Russian Federation, and analyze the efficacy of eradication regimens. In all HPinfected individuals, HP leads to chronic inflammation in the gastric mucosa and launches a precancerous cascade (Correa's cascade). The risk of gastric cancer increases with severe atrophy, intestinal metaplasia and dysplasia. Primary prevention of gastric cancer is most effective if the eradication is performed before atrophic gastritis develops. The available consensus documents underline the importance of HP infection identification by accurate diagnostics at this stage of chronic gastritis. In Russia, the primary HP diagnosis is based on histology (37.7%), rapid urease test (29.2%), and serology (29.7%). HP stool antigen test (31.3%), 13C-urea breath test (23.4%) and the histological method (23.3%) are most often used to control eradication. Currently, the first line of eradication therapy is recommended as triple therapy with clarithromycin prescribed for 14 days. It is recommended to use double dose of proton pump inhibitors and bismuth to increase the effectiveness of this scheme. A 14-days triple regimen enhanced by bismuth has been recommended as the first-line therapy in the Russian Federation.

About the authors

I. N. Voynovan

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: i.voynovan@mknc.ru
ORCID iD: 0000-0002-5584-8514

Irina N. Voynovan – Junior Research Fellow, Division of Pathology of Upper Digestive Tract

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

Yu. V. Embutnieks

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: y.embutnieks@mknc.ru
ORCID iD: 0000-0002-6479-9515

Yuliya V. Embutnieks – MD, PhD, Head of the Division of Pathology of Upper Digestive Tract

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

D. V. Mareeva

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: dmareeva@mail.ru
ORCID iD: 0000-0002-4172-8482

Dariya V. Mareeva – MD, PhD, Gastroenterologist, Clinical and Diagnostic Department

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

S. V. Kolbasnikov

Tver State Medical University

Email: kabinet208@mail.ru
ORCID iD: 0000-0002-9223-0457

Sergey V. Kolbasnikov – MD, PhD, Professor, Head of the Chair of General Medical Practice (Family Medicine), Faculty of Postgraduate Studies

4 Sovetskaya ul., Tver, 170100

Russian Federation

D. S. Bordin

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department;
Tver State Medical University;
A.I. Yevdokimov Moscow State University of
Medicine and Dentistry

Author for correspondence.
Email: d.bordin@mknc.ru
ORCID iD: 0000-0003-2815-3992

Dmitry S. Bordin – MD, PhD, Head of Division of Pathology of the Pancreas, Biliary Tract and Upper Digestive Tract Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department; Professor of Chair of General Medical Practice (Family Medicine), Faculty of Postgraduate Studies Tver State Medical University; Professor of Chair of Internal Diseases Propedeutics and Gastroenterology A.I. Yevdokimov Moscow State University of Medicine and Dentistry

86 Shosse Entuziastov, Moscow, 111123

 

Russian Federation

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Copyright (c) 2019 Voynovan I.N., Embutnieks Y.V., Mareeva D.V., Kolbasnikov S.V., Bordin D.S.

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