The Colombian Chemoprevention Trial: 20-Year Follow-Up of a Cohort of Patients With Gastric Precancerous Lesions

Area of Science:

• Gastroenterology
• Oncology
• Infectious Diseases

Background:

• Gastric cancer (GC) risk is reduced by Helicobacter pylori eradication and endoscopic surveillance of precancerous lesions.
• This study represents the longest prospective cohort of an H. pylori eradication trial in a Hispanic population.

Purpose of the Study:

• To evaluate the long-term effects of H. pylori eradication on the progression of gastric precancerous lesions in a high-risk Hispanic population.
• To assess the risk of gastric cancer associated with different subtypes and locations of intestinal metaplasia.

Main Methods:

• 800 adults with precancerous lesions were randomized to H. pylori treatment or placebo.
• Gastric biopsies were assessed over 20 years using the Correa histopathology score.
• Generalized linear mixed models and logistic regression analyzed H. pylori status, lesion progression, and GC risk.

Main Results:

• Anti-H. pylori therapy reduced Correa score progression (OR, 0.59; 95% CI, 0.38-0.93).
• H. pylori-negative status showed a beneficial effect on the score over time (P = .036).
• Incomplete-type intestinal metaplasia significantly increased GC risk (OR, 13.4; 95% CI, 1.8-103.8).

Conclusions:

• Long-term anti-H. pylori therapy benefits Hispanic populations by reducing histologic progression of precancerous gastric lesions.
• Incomplete intestinal metaplasia is a strong predictor of gastric cancer risk in this population.