治疗幽门螺旋杆菌的抗生素可以预防胃癌


  【24drs.com】根据在线发表于7月22日考科蓝系统性文献回顾资料库针对6篇试验的系统性回顾,消除幽门螺旋杆菌(Helicobacter pylori)可以降低健康人的胃癌风险,有5篇阳性试验是在亚洲人进行,作者们提醒,我们还无法将这些资料推论到其它族群。
  
  根除引起消化性溃疡之幽门螺旋杆菌的治疗,包括1至2周疗程的抗生素,单独使用或者并用制酸剂、铋制剂。
  
  为了此篇回顾,研究者考量的是比较根除治疗与安慰剂或无治疗的随机控制试验,这些试验包括了6,497名健康、无症状、细菌检测阳性的成人;胃癌定义为任何的胃腺癌,包括肠道(分化)或弥漫性(未分化)类型、或没有特定组织。
  
  根据中等质量的证据,抗生素治疗组中,胃癌发生率为51/3294,相较于(对照组)的76/3203,风险比为0.66(95%信赖区间[CI],0.46 - 0.95)。
  
  只有1篇试验报告了食道癌,治疗组的817名病患中有2例、安慰剂组有1例(风险比[RR],1.99;95% CI,0.18 - 21.91);这些试验都没有提到其它不良事件,促使回顾作者写道,我们无法评估将幽门螺旋杆菌筛检与治疗纳入公卫检测的利弊得失。
  
  各组之间的所有原因死亡风险没有差异(RR为1.09;95% CI 0.86-1.38),作者们无法评估胃癌的死亡率风险,因为信赖区间太宽(RR,0.67;95% CI,0.40 - 1.11)。
  
  英国圣詹姆斯大学医院、Leeds大学的Alexander Ford在期刊新闻稿中表示,这篇回顾强调,必须在不同族群进行后续试验,以提供更多证据,且应报告这类方法的好处与坏处。
  
  资料来源:http://www.24drs.com/
  
  Native link:Antibiotics for H pylori May Prevent Gastric Cancer

Antibiotics for H pylori May Prevent Gastric Cancer

By Beth Skwarecki
Medscape Medical News

Eliminating the bacterium Helicobacter pylori can reduce the risk for gastric cancer in healthy individuals, according to a systematic review of six trials published online July 22 in the Cochrane Database of Systematic Reviews. The five positive trials were done in Asian populations, and the authors caution that "we cannot necessarily extrapolate this data to other populations."

Therapy to eradicate H pylori, a known cause of peptic ulcers, consists of a 1- to 2-week course of antibiotics either alone or in combination with acid suppressant therapy, bismuth, or both.

For the current review, the investigators considered randomized controlled trials that compared eradication with placebo or with no treatment. The trials included 6497 healthy, asymptomatic adults who tested positive for the presence of the bacterium. Gastric cancer was defined as any gastric adenocarcinoma, including intestinal (differentiated) or diffuse (undifferentiated) type or without specified histology.

In the antibiotic-treatment group, the incidence of gastric cancer was 51 of 3294 people compared with 76 of 3203, a risk ratio of 0.66 (95% confidence interval [CI], 0.46 - 0.95), based on moderate-quality evidence.

Only one trial reported on esophageal cancer, with two cases out of 817 patients in the treatment group compared with one in the placebo group (risk ratio [RR], 1.99; 95% CI, 0.18 - 21.91). None of the trials reported other adverse events, leading the review authors to write that "we were unable to assess the balance of benefits and harms if population screening and treatment for H. pylori infection were to be adopted as a public health measure."

The risk for death from all causes did not differ between groups (RR 1.09; 95% CI 0.86 to 1.38), and the authors could not asses the mortality risk from gastric cancer because of the wide confidence intervals (RR, 0.67; 95% CI, 0.40 - 1.11).

"The review highlights the need for further trials in different populations to provide more evidence, and these should report both the benefits and harms of such an approach," lead author Alexander Ford, MBChB, MD, from St. James's University Hospital and Leeds University in the United Kingdom, said in a journal news release.

The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online July 22, 2015.

    
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