From the Research
The development of gastric cancer from H. pylori infection typically takes 20-40 years. This lengthy process involves a series of progressive changes in the stomach lining, beginning with chronic gastritis, followed by atrophic gastritis, intestinal metaplasia, dysplasia, and finally invasive carcinoma. This sequence, known as Correa's cascade, is a gradual transformation that occurs over decades 1. The long latency period explains why gastric cancer is predominantly diagnosed in older adults, usually after age 50, despite H. pylori infection often being acquired in childhood. Not everyone with H. pylori will develop cancer; only about 1-3% of infected individuals ultimately progress to malignancy. This risk is influenced by bacterial virulence factors (particularly CagA and VacA strains), host genetic susceptibility, dietary factors, and environmental exposures. Early eradication of H. pylori, particularly before atrophic changes occur, can significantly reduce cancer risk, highlighting the importance of testing and treating this infection in high-risk populations 2.
Some key points to consider in the management and prevention of gastric cancer related to H. pylori infection include:
- The importance of early eradication of H. pylori to prevent the progression to gastric cancer 3
- The use of effective treatment regimens such as proton-pump inhibitor and amoxicillin-based triple therapy containing clarithromycin or metronidazole 4
- The need for testing and treatment in high-risk populations, particularly those with a family history of gastric cancer or living in areas with high prevalence of the disease 5
- The role of dietary and environmental factors in influencing the risk of gastric cancer, such as low intake of vegetables and fruits, high salt consumption, smoking, and alcohol consumption 1
Overall, the management of H. pylori infection and the prevention of gastric cancer require a comprehensive approach that includes early diagnosis, effective treatment, and lifestyle modifications. Early eradication of H. pylori is crucial in preventing the development of gastric cancer, and healthcare providers should prioritize testing and treatment in high-risk populations 2.