Paris, january 30, 2003
GEPH Press release (French working group on Helicobacter)
THE HELICOBACTER PYLORI BACTERIUM TO PREVENT GASTRIC CANCER
During a press conference at the Institut Pasteur on Thursday 30 January 2003, the Groupe d'Etudes Français des Helicobacter, GEFH, recommended the extension of testing for Helicobacter pylori bacteria and the eradication of this bacterium in all infected individuals in order to prevent gastric cancers. Today, it has been clearly proved that this bacterium is responsible for this type of cancer. Epidemiological studies have proved that no gastric cancer develops in the absence of Helicobacter pylori. Reliable and non-invasive means of diagnosis exist and highly effective treatment clears up infection in 90% of patients.
The GEFH considers that
it is indispensable to systematically check for the presence of Helicobacter
pylori bacteria in high-risk groups:
- patients having had a partial gastrectomy for cancer;
- direct relatives of patients with gastric cancer;
- patients with preneoplasic lesions (atrophic gastritis...)
For individuals with no identified risk factor, GEFH also recommends testing and that treatment be suggested to all those infected and part of a welfare system.
The currently recommended treatment for infection by Helicobacter pylori in France is triple therapy for 7 days combining a powerful inhibitor of gastric acidity (double dose of proton pump inhibitor) and two antibiotics, usually amoxicillin and clarithromycin.
In 70% of cases, bacteria are eradicated after initial treatment. Factors in failure are primary resistance to clarithromycin in 12 to 14% of cases, incorrect administration of treatment, age (less than 50 years old) and smoking.
90% of patients are cured of their infection after a second dose of treatment.
The treatment eradicates all bacteria and all signs of infection in a few days. Inflammation continues for 6 to 24 months before the mucous membrane resumes normal state. Should atrophy of the mucous membrane or an intestinal metaplasia exist, these anomalies will not be removed, but they will no longer spread or be aggravated.
According to Pr Delchier, Chairman of the GEFH, "Recent studies have shown the major role played by Helicobacter pylori in causing gastric cancer. The prognostic is bad - 25% survival over five years - due to often late diagnosis. And yet, today we have the means to prevent the appearance of this cancer, by checking for helicobacter pylori and eradicating the bacteria in all infected individuals".
The latest epidemiological data shows that the most frequent gastric cancer, intestinal adenocarcinoma, nearly always appears following evolution of an inflammation of the gastric mucous membrane caused by chronic infection due to Helicobacter pylori.
A Japanese study following 1500 individuals over a 7/8-year period showed that gastric cancer only occurred in patients infected by Helicobacter pylori.
In 2003 we could say : "No Helicobacter pylori, no cancer."
In this way, Helicobacter pylori is the first bacteria at the origin of the second most common cancer in the world, stomach cancer, .
In France, gastric cancer is the second most common digestive cancer in terms of annual cases. 9,000 new cases are diagnosed each year (34,000 for colon cancer), i.e. one case for every 7,000 inhabitants.
Infection by Helicobacter pylori occurs in childhood. In most cases, this develops into a chronic disease, lasting several decades or a lifetime. With most individuals, chronic gastritis evolves without consequences and remains asymptomatic. Roughly 10% of infected individuals will develop an ulcer condition and 1% will develop gastric cancer. Recent data shows that evolution to a duodenal ulcer or gastric cancer are mutually exclusive, and that evolution to one of the two pathologies depends on genetic predisposition. Evolution to a duodenal ulcer is associated with antral gastritis of the stomach and acid hyper-secretion while evolution to gastric atrophy followed by cancer is associated with pangastritis (gastritis of the antrum and the fundus) and acid hypo-secretion.
In France, testing and treatment for Helicobacter pylori are only currently recommended for patients with a proven ulcer and for patients with MALT, a rare tumour likely to regress following anti-Helicobacter pylori treatment.
These recommendations would have to be modified to extend testing. To begin with, systematic gastric biopsies could be recommended with gastric endoscopies.
- Pr. Delchier, Gastroenterology service, Henri-Mondor Hospital, 94010 Créteil Cedex -Tel. +33 (0)1 49 81 23 51
- Dr. Lamarque, Gastroenterology
service, Bichat Hospital, 75877 Paris -
Tel. +33 (0)1 40 25 72 00
- Dr. Courillon-Mallet, Gastroenterology service, Hospital, 94195 Villeneuve Saint Georges - Tel. +33 (0)1 43 86 21 84
- Pr. Mégraud, C.H.U.
Pellegrin, Bacteriology lab., 33076 Bordeaux -
Tel. +33 (0)5 56 79 59 10
- Pr. Labigne, Pathogenesis of Mucosal Microbe Unit, Institut Pasteur, 75724 Paris- Tel. +33 (0)1 45 68 83 43
- Dr. P. Vincent, Centre Hospitalier, 59037 Lille Cedex - Tel. +33 (0)3 20 87 11 93
- Dr. J. Raymond, Microbiology laboratory, Saint-Vincent de Paul Hospital, 75674 Paris Cedex 14 - Tel. +33 (0)1 40 48 82 42
- Pr J-D. de Korwin, H.
medicine service CHU, 54035 Nancy Cedex -
Tel. +33 (0)3 83 85 26 78
- Pr. J.-L. Fauchère
and Dr. C. Burucoa, Microbiology laboratory A, CHU, 86021 Poitiers Cedex - Tel.
+33 (0)5 49 44 43 53