治療幽門螺旋桿菌的抗生素可以預防胃癌


  【24drs.com】根據線上發表於7月22日考科藍系統性文獻回顧資料庫針對6篇試驗的系統性回顧,消除幽門螺旋桿菌(Helicobacter pylori)可以降低健康人的胃癌風險,有5篇陽性試驗是在亞洲人進行,作者們提醒,我們還無法將這些資料推論到其他族群。
  
  根除引起消化性潰瘍之幽門螺旋桿菌的治療,包括1至2週療程的抗生素,單獨使用或者併用制酸劑、鉍製劑。
  
  為了此篇回顧,研究者考量的是比較根除治療與安慰劑或無治療的隨機控制試驗,這些試驗包括了6,497名健康、無症狀、細菌檢測陽性的成人;胃癌定義為任何的胃腺癌,包括腸道(分化)或瀰漫性(未分化)類型、或沒有特定組織。
  
  根據中等品質的證據,抗生素治療組中,胃癌發生率為51/3294,相較於(對照組)的76/3203,風險比為0.66(95%信賴區間[CI],0.46 - 0.95)。
  
  只有1篇試驗報告了食道癌,治療組的817名病患中有2例、安慰劑組有1例(風險比[RR],1.99;95% CI,0.18 - 21.91);這些試驗都沒有提到其他不良事件,促使回顧作者寫道,我們無法評估將幽門螺旋桿菌篩檢與治療納入公衛檢測的利弊得失。
  
  各組之間的所有原因死亡風險沒有差異(RR為1.09;95% CI 0.86-1.38),作者們無法評估胃癌的死亡率風險,因為信賴區間太寬(RR,0.67;95% CI,0.40 - 1.11)。
  
  英國聖詹姆斯大學醫院、Leeds大學的Alexander Ford在期刊新聞稿中表示,這篇回顧強調,必須在不同族群進行後續試驗,以提供更多證據,且應報告這類方法的好處與壞處。
  
  資料來源:http://www.24drs.com/
  
  Native link:Antibiotics for H pylori May Prevent Gastric Cancer

Antibiotics for H pylori May Prevent Gastric Cancer

By Beth Skwarecki
Medscape Medical News

Eliminating the bacterium Helicobacter pylori can reduce the risk for gastric cancer in healthy individuals, according to a systematic review of six trials published online July 22 in the Cochrane Database of Systematic Reviews. The five positive trials were done in Asian populations, and the authors caution that "we cannot necessarily extrapolate this data to other populations."

Therapy to eradicate H pylori, a known cause of peptic ulcers, consists of a 1- to 2-week course of antibiotics either alone or in combination with acid suppressant therapy, bismuth, or both.

For the current review, the investigators considered randomized controlled trials that compared eradication with placebo or with no treatment. The trials included 6497 healthy, asymptomatic adults who tested positive for the presence of the bacterium. Gastric cancer was defined as any gastric adenocarcinoma, including intestinal (differentiated) or diffuse (undifferentiated) type or without specified histology.

In the antibiotic-treatment group, the incidence of gastric cancer was 51 of 3294 people compared with 76 of 3203, a risk ratio of 0.66 (95% confidence interval [CI], 0.46 - 0.95), based on moderate-quality evidence.

Only one trial reported on esophageal cancer, with two cases out of 817 patients in the treatment group compared with one in the placebo group (risk ratio [RR], 1.99; 95% CI, 0.18 - 21.91). None of the trials reported other adverse events, leading the review authors to write that "we were unable to assess the balance of benefits and harms if population screening and treatment for H. pylori infection were to be adopted as a public health measure."

The risk for death from all causes did not differ between groups (RR 1.09; 95% CI 0.86 to 1.38), and the authors could not asses the mortality risk from gastric cancer because of the wide confidence intervals (RR, 0.67; 95% CI, 0.40 - 1.11).

"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," lead author Alexander Ford, MBChB, MD, from St. James's University Hospital and Leeds University in the United Kingdom, said in a journal news release.

The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online July 22, 2015.

    
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