H. pylori eradication
Helicobacter pylori eradication for gastric cancer prevention. Cancer. Reviewed Oct 2026.
Eradication clearly lowers gastric cancer incidence where the bacterium and the cancer are common, but the largest pooled analysis shows no all-cause mortality benefit, and no country with Austria's incidence screens for it.
What it is
A one-to-two-week course of antibiotics plus acid suppression that clears Helicobacter pylori, the stomach bacterium behind most gastric cancer. Treating a confirmed infection is already routine; the open question is how much population-wide screening lowers cancer risk, for whom, and at what cost in antibiotic use.
The evidence
Randomised: the Shandong/Linqu trial (n=2258, placebo-controlled) cut gastric cancer incidence by 39% at 14.7 years; its 22.3-year follow-up (BMJ 2019, PMID 31511230) confirmed OR 0.48 (CI 0.32–0.71) and a gastric-cancer-specific mortality HR of 0.62 (CI 0.39–0.99) — one trial, one high-incidence Chinese county, a CI that barely clears 1, and not an all-cause result. The Matsu Islands mass-eradication program (Gut 2021, PMID 32792335) is a before-after cohort, not an RCT: incidence fell 53%, but its 25% mortality reduction was NOT significant. Negative evidence: the largest pooled meta-analysis (PMC12010618) found all-cause mortality unchanged (RR 1.00, CI 0.89–1.13) and stomach-cancer mortality not significant (RR 0.84, CI 0.69–1.01), with NNT in healthy adults of 476 — roughly six times Cochrane's 2020 estimate of 72 (PMC7389270). Bigger data made the effect look smaller. Clarithromycin resistance now runs about 30–33% globally and is rising, eroding first-line triple therapy; treatment is systemic antibiotics with microbiome cost and real re-infection risk. No professional body recommends population screening in low-incidence countries such as Austria or Germany — the 760,000 figure is a global sum dominated by East Asia, not an argument for testing everyone in Vienna.
What you can do today
Not available for this use, and years away if it arrives at all. Anything sold today with this claim is not backed by human evidence for it.
Sources
- Coverage, not a sourceiarc.who.int
No primary paper or registry record is linked for this entry yet. The evidence summary names the studies it relies on.
Change history
H. pylori eradication for gastric cancer prevention added to Cancer, graded B.
IARC's 760,000-cases-a-year figure is real, but the eradication evidence splits: randomised incidence reduction in high-incidence Asian populations against no all-cause mortality benefit when pooled, and no screening recommendation in low-incidence countries. The source thread, an uncited supplement protocol attached to a paid coaching funnel, was kept out of the feed.
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