[Helicobacter pylori and stomach cancer]

A number of epidemiological studies and summaries of such studies in the form of meta-analyses have shown a significant relationship between Helicobacter pylori infections of the gastric mucosa and the incidence of gastric cancer. The risk of developing stomach cancer is on average six times higher in the presence of H.p. In countries such as Austria, some 1% of H.p. positives develop gastric cancer in the course of their lives, while only one per 750 noninfected individuals do so. The molecular basis is unclear, but a defect in the tumor-suppressor gene p53 seems to play an important role. As H.p. infection is common (some 30% of the total population in Austria is infected) and gastric cancer without H.p. eradication has become less common (in 1997 there were 24 new cases per 100,000 population), H.p. eradication is not advised as prophylaxis for gastric cancer. Patients who have a positive family history of gastric cancer and those who have had surgery for gastric cancer should, however, according to the Maastricht recommendations, undergo eradication. An example is given to show that in comparison with other measures for cancer screening or prevention, the cost of 120,000 ATS per prevented gastric cancer would be a very good investment with general eradication of H.p. in all individuals over 50 years of age.