Helicobacter pylori and gastric cancer

A number of epidemiological studies and summaries of such studies in the fo rm of metaanalyses have shown a significant relationship between Helicobaot er pylori infections of the gastric mucosa and the incidence of gastric can cer. The risk of developing stomach cancer is on average six times higher i n the presence of H.p. In countries such as Austria, some 1 % of H.p. posit ives develop gastric cancer in the course of their lives, while only one pe r 750 noninfected individuals do so. The molecular basis is unclear, but a defect in the tumor-suppressor gene p53 seems to play an important role. As H.p. infection is common (some 30 % of the total population in Austria is infected) and gastric cancer without H.p. eradication has become less commo n (in 1997 there were 24 new cases per 100.000 population), H.p. eradicatio n is not advised as prophylaxis for gastric cancer. Patients who have a pos itive family history of gastric cancer and those who have had surgery for g astric cancer should, however, according to the Maastricht recommendations, undergo eradication. An example is given to show that in comparison with o ther measures for cancer screening or prevention, the cost of 120.000 ATS p er prevented gastric cancer would be a very good investment with general er adication of H.p. in all individuals over 50 years of age.