Helicobacter pylori infection and risk of gastric cancer
Authors: Yung-Shuo Kao, Chih-Wei Chen, James Cheng-Chung Wei
Journal: The Lancet Public Health (2022)

We read with great interest the study by Ling Yang and colleagues,1Yang L Kartsonaki C Yao P et al.The relative and attributable risks of cardia and non-cardia gastric cancer associated with Helicobacter pylori infection in China: a case-cohort study.Lancet Public Health. 2021; 6: e888-e896Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar which uniquely showed the association between risk of cardia gastric cancer and Helicobacter pylori infection. However, we would like to raise some concerns. First, this study is a multi-institutional cohort study. The diagnosis of oesophageal adenocarcinoma, cardia, and non-cardia gastric cancer is dependent on diagnostic criteria used by physicians from different institutions.2Van Cutsem E Sagaert X Topal B Haustermans K Prenen H Gastric cancer.Lancet. 2016; 388: 2654-2664Summary Full Text Full Text PDF PubMed Scopus (1145) Google Scholar Hence, we question if the diagnostic criteria among various institutions could influence the association. Second, the diagnosis of H pylori infection was based on blood sample. However, the uncertainty of the H pylori infection status (eg, acute or treated), which is not detected by a blood sample, could weaken the conclusion that this type of cancer is associated with H pylori infection. Therefore, other diagnostic techniques for H pylori should be used to validate the conclusion.3Wang YK Kuo FC Liu CJ et al.Diagnosis of Helicobacter pylori infection: current options and developments.World J Gastroenterol. 2015; 21: 11221-11235Crossref PubMed Scopus (165) Google Scholar Third, this study focused on the association between risk of gastric cancer and H pylori infection in Chinese patients only, and other ethnic groups and interference factors (eg, immune diseases) were not considered. For example, H pylori infection could result in an increased risk of systemic lupus erythematosus,4Wu MC Leong PY Chiou JY Chen HH Huang JY Wei JC Increased risk of systemic lupus erythematosus in patients with Helicobacter pylori infection: a nationwide population-based cohort study.Front Med (Lausanne). 2020; 6: 330Crossref PubMed Scopus (8) Google Scholar leading to an increased risk of cancer.5Song L Wang Y Zhang J Song N Xu X Lu Y The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis.Arthritis Res Ther. 2018; 20: 270Crossref PubMed Scopus (46) Google Scholar Thus, we suggest that the authors consider other ethnic groups and interference factors in their research to add value to the study. Overall, this study contributed to understanding the association between risk of gastric cancer and H pylori infection. However, further studies should be conducted regarding the diagnostic criteria for gastric cancers and H pylori infection, while considering other potential factors. We declare no competing interests. The relative and attributable risks of cardia and non-cardia gastric cancer associated with Helicobacter pylori infection in China: a case-cohort studyAmong Chinese adults, H pylori infection is common and is the cause of large numbers of gastric cancer cases. Population-based mass screening and the eradication of H pylori should be considered to reduce the burden of gastric cancer in high-risk settings. Full-Text PDF Open AccessHelicobacter pylori infection and risk of gastric cancer – Authors' replyWe thank Yung-Shuo Kao and colleagues for their interest in our study of the association between Helicobacter pylori infection and risk of gastric cancer in Chinese populations.1 Our study was nested within the prospective China Kadoorie Biobank (CKB) study of over half a million adults recruited from ten geographically defined areas across China. We agree that the criteria and quality of gastric cancer diagnosis, including clinical manifestations and endoscopic, histopathological, or imaging examinations,2 vary between hospitals or institutions. Full-Text PDF Open Access