Mide kanseri, Helicobacter pylori adlı bakteriye karşı antibiyotik kullanmak ile azaltılabilinir mi?

 Helicobacter pylori bakterisi mide kanseri riskini ve dudenum ülserinin önemli faktörlerinden biridir.

 Cochrane Library, temmuz ayında çıkan bir analize göre, semptomu(şikayet ve belirtiler olmadan), H. Pylori pozitif olanları tedavi etmek mide kanserini ve mide kanserine bağlı ölümleri azaltıyor
 Mide kanseri dünyada kansere bağlı ölümlerde üçüncü nedendir
 Peki bu çalışmaya göre Helicobacter pylori olanlara antiyobiyotik başlayalım mı?
 Çalışmanın detayına bakmalıyız
 Bu analizde 6 çalışma alınmış, bunların 5 uzak doğu Asya kökenli(Çin, Japon vs.)
 Toplam 6.497 sağlıklı, kanser olmayan, Helicobacter pylori pozitif denek alınmış
 Bir guruba antibiyotik, bir guruba plasebo verilmiş ve yaklaşık 2 yıl boyunca izlenmişler.
 Antibiyotik alan grupta mide kanseri % 34 daha az saptanmış. Aynı zamanda mide kanserine bağlı ölümlerde %33 daha az saptanmış.
 Fakat tüm nedenlere bağlı ölümler her iki gurupta aynı oranda saptanmış
 Bu çalışmaya göre semptomu olmayan Helicobacter pylori pozitif olanlara antibiyotik başlayalım mı?
 Makalenin yazarlarının da belirttiği gibi bu verilerle hayır
 Neden hayır
 Çünkü çalışmaya katılanların çoğu Asya ırkında ve mide kanseri oranı yüksek, diğer toplumlara göre farklı seyredebiliyor
 Birde çalışmanın detayında belirtildiği gibi, genel ölüm iki gurupta aynı düzeyde. Yani mide kanseri ve mide kanserine bağlı ölümü azaltıyor olabilir. Fakat daha önceki çalışmalarda da belirtildiği gibi, Helicobacter pylori tedavisi, reflü ve yemek borusu kanserini ve artırabiliyor.

SONUÇ: Şikâyeti, semptomu olmayan, sağlıklı bireylerde, Helicobacter pylori olan bireylere mevcut bilgiler ışığında antibiyotik tedavisi önerilemez. Fakat mide kanserini azatlığı özelikle Asya toplumunda azatlığı gösterilmiştir. Daha kapsamlı çalışmaların sonucu beklenmelidir.

KAYNAK:

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News · July 26, 2015
Review: Eradicating H. pylori Cuts Incidence of Gastric Cancer
Reduction in the incidence of gastric cancer with tx of asymptomatic, otherwise healthy individuals
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Eradication ofHelicobacter pylori in asymptomatic adults is associated with a reduction in the incidence of gastric cancer, according to a review published online July 22 in The Cochrane Library.
FRIDAY, July 24, 2015 (HealthDay News) — Eradication of Helicobacter pylori in asymptomatic adults is associated with a reduction in the incidence of gastric cancer, according to a review published online July 22 in The Cochrane Library.
Alexander C. Ford, M.B., Ch.B., M.D., from St. James’s University Hospital in Leeds, U.K., and colleagues examined the effectiveness of H. pylori eradication in healthy asymptomatic individuals in the general population in reducing the incidence of gastric cancer. Data were included from six trials (five in Asian populations) which compared at least one week of H. pylori therapy with placebo or no treatment in otherwise healthy and asymptomatic H. pylori-positive adults.
The researchers found that H. pylori eradication therapy was superior to placebo or no treatment for preventing development of subsequent gastric cancer (six trials, 6,497 participants; risk ratio, 0.66; 95 percent confidence interval, 0.46 to 0.95). Wide confidence intervals were seen on analysis of the effect of H. pylori eradication on preventing death from gastric cancer compared with placebo or no treatment (three trials, 4,475 participants; risk ratio, 0.67; 95 percent confidence interval, 0.40 to 1.11). No effect was seen on all-cause mortality (four trials; 5,253 participants; risk ratio, 1.09; 95 percent confidence interval, 0.86 to 1.38).
“We found limited, moderate-quality evidence that searching for and eradicating H. pylori reduces the incidence of gastric cancer in healthy asymptomatic infected Asian individuals, but we cannot necessarily extrapolate this data to other populations,” the authors write.
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Targeting Helicobacter Pylori Bacterium May Help Prevent Stomach Cancer
July 22, 2015
LONDON — July 22, 2015 — A new review published in the Cochrane Library, indicates that eradicating Helicobacter pylori bacterium, the main cause of stomach ulcers, with a short course of therapy comprising 2 commonly used medicines may help to reduce the risk of gastric cancer. Stomach cancer is the third most common cause of death from cancer worldwide, and people who are infected with the Helicobacter pylori bacterium are more likely to develop the disease.
To determine whether eliminating H. pylori might reduce the incidence of gastric cancer, researchers analysed all published randomised controlled trials comparing at least 1week of H. pylori therapy, with placebo or no treatment, in otherwise healthy and asymptomatic H. pylori-positive adults. The review included only trials that followed participants for at least 2 years and that had at least 2 participants who developed gastric cancer.
Six trials with a total of nearly 6500 participants met the researchers’ criteria. One study was conducted in Colombia and the remainder were conducted in Asian countries, with 4 in China and1 in Japan where stomach cancer is more common. The studies mainly used a combination of antibiotics with proton pump inhibitors. An analysis of the studies results revealed that combining antibiotics with gastric acid suppressor therapy given for between 1 and 2 weeks prevented the development of gastric cancer compared with placebo or no treatment: in the studies, 51/3294 (1.6%) of the people given H. pylori treatment developed gastric cancer compared with 76/3203 (2.4%) given no treatment or a placebo. However, the number of deaths from gastric cancer in the trials was low, and there was insufficient evidence to be certain whether eradication improved survival.
“The findings of this systematic review and meta-analysis add to the increasing evidence that eradicating H. pylori in the general population has the potential to prevent gastric cancer. International guidelines for the management of H. pylori infection may change as a result,” said co-author Paul Moayyedi, MB ChB, PhD, MPH, McMaster University, Hamilton , Ontario. “More research is needed on the extent of this effect and on any potential harms of H. pylori treatment before it can be advocated as a means of preventing gastric cancer.“
“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,” said lead author Alex Ford, MD, St. James’s University Hospital and Leeds University, Leeds, United Kingdom.
SOURCE: Cochrane Library