© The Author 2006. Published by Oxford University Press.
ARTICLE |
Randomized Double-Blind Factorial Trial of Three Treatments To Reduce the Prevalence of Precancerous Gastric Lesions
Affiliations of authors: Peking University School of Oncology, Beijing Cancer Hospital and Beijing Institute for Cancer Research, Beijing, China (WY, LZ, JL, MJ, YC, JM, KP, GX); Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (LMB, JFF, MHG); Linqu County Public Health Bureau, Shandong, China (WL); Westat, Rockville, MD (YH, SCM); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Ltd., Rockville, MD, and Vanderbilt University, Nashville, TN (WJB)
Correspondence to: Mitchell Gail, MD, PhD, National Cancer Institute, 6120 Executive Blvd., EPS 8032, Bethesda, MD 20892-7244 (e-mail: gailm{at}mail.nih.gov).
Background: Randomized trials have yielded mixed results on the effects of treatment for Helicobacter pylori and little information on the effects of vitamins or garlic supplements on precancerous gastric lesions. We conducted a randomized trial to test the effects of one-time H. pylori treatment and long-term vitamin or garlic supplements in reducing the prevalence of advanced precancerous gastric lesions. Methods: Most of the adults aged 35–64 years in 13 randomly selected villages in Linqu County, Shandong Province, China, were identified and given baseline endoscopies in 1994. In 1995, 3365 eligible subjects were randomly assigned in a factorial design to three interventions or placebos: amoxicillin and omeprazole for 2 weeks in 1995 (H. pylori treatment); vitamin C, vitamin E, and selenium for 7.3 years (vitamin supplement); and aged garlic extract and steam-distilled garlic oil for 7.3 years (garlic supplement). Subjects underwent endoscopies with biopsies in 1999 and 2003, and the prevalence of precancerous gastric lesions was determined by histopathologic examination of seven standard biopsy sites. The 3365 eligible randomized subjects represented 93.5% of those with baseline endoscopy and included all baseline histologic categories except gastric cancer. Only 0.18% had normal gastric mucosa. Logistic regression was used to estimate the intervention effects on the odds of advanced precancerous gastric lesions, and t-tests were used to assess effects on histologic severity. All statistical tests were two-sided. Results: H. pylori treatment resulted in statistically significant decreases in the combined prevalence of severe chronic atrophic gastritis, intestinal metaplasia, dysplasia, or gastric cancer in 1999 (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.62 to 0.95) and in 2003 (OR = 0.60; 95% CI = 0.47 to 0.75), and had favorable effects on the average histopathologic severity and on progression and regression of precancerous gastric lesions in 2003. H. pylori treatment did not reduce the combined prevalence of dysplasia or gastric cancer. However, fewer subjects receiving H. pylori treatment (19/1130; 1.7%) than receiving placebo (27/1128; 2.4%) developed gastric cancer (adjusted P = .14). No statistically significant favorable effects were seen for garlic or vitamin supplements. Conclusion: H. pylori treatment reduces the prevalence of precancerous gastric lesions and may reduce gastric cancer incidence, but further data are needed to prove the latter point. Long-term vitamin or garlic supplementation had no beneficial effects on the prevalence of precancerous gastric lesions or on gastric cancer incidence.
CiteULike 
Connotea 
Del.icio.us What's this?
Correspondence about this Article
- Re: Randomized Double-Blind Factorial Trial of Three Treatments to Reduce the Prevalence of Precancerous Gastric Lesions
- Robertino Mera, Elizabeth T. H. Fontham, Luis E. Bravo, Juan C. Bravo, M. Blanca Piazuelo, M. Constanza Camargo, and Pelayo Correa
J Natl Cancer Inst 2006 98: 1426.[Extract] [Full Text] [PDF]
Editorial about this Article
- (Nutritional) Chemoprevention of Cancer: What's Up?
- John A. Baron
J Natl Cancer Inst 2006 98: 945-946.[Extract] [Full Text] [PDF]
This article has been cited by other articles:
|
|
 |
|
  M. J. Blaser Understanding Microbe-Induced Cancers Cancer Prevention Research, June 1, 2008; 1(1): 15 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Yeh, K. M. Kuntz, M. Ezzati, C. Hur, C. Y. Kong, and S. J. Goldie Development of an Empirically Calibrated Model of Gastric Cancer in Two High-Risk Countries Cancer Epidemiol. Biomarkers Prev., May 1, 2008; 17(5): 1179 - 1187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-W. Lee, B. Rickman, A. B. Rogers, Z. Ge, T. C. Wang, and J. G. Fox Helicobacter pylori Eradication Prevents Progression of Gastric Cancer in Hypergastrinemic INS-GAS Mice Cancer Res., May 1, 2008; 68(9): 3540 - 3548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Hamashima, D. Shibuya, H. Yamazaki, K. Inoue, A. Fukao, H. Saito, and T. Sobue The Japanese Guidelines for Gastric Cancer Screening Jpn. J. Clin. Oncol., April 1, 2008; 38(4): 259 - 267. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. R. Taylor Prevention of Gastric Cancer: A Miss J Natl Cancer Inst, January 17, 2007; 99(2): 101 - 103. [Full Text] [PDF]
|
|
|
|
|
|
M. Plummer, J. Vivas, G. Lopez, J. C. Bravo, S. Peraza, E. Carillo, E. Cano, D. Castro, O. Andrade, V. Sanchez, et al. Chemoprevention of Precancerous Gastric Lesions With Antioxidant Vitamin Supplementation: A Randomized Trial in a High-Risk Population J Natl Cancer Inst, January 17, 2007; 99(2): 137 - 146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 JournalScan Gut, November 1, 2006; 55(11): 1639 - 1639. [Full Text] [PDF]
|
|
|
|
|
|
O. Nyren and W. J. Blot Helicobacter pylori Infection: Mainly Foe but Also Friend? J Natl Cancer Inst, October 18, 2006; 98(20): 1432 - 1434. [Full Text] [PDF]
|
|
|
|
|
|
R. Mera, E. T. H. Fontham, L. E. Bravo, J. C. Bravo, M. B. Piazuelo, M. C. Camargo, and P. Correa Re: Randomized double-blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions. J Natl Cancer Inst, October 4, 2006; 98(19): 1426 - 1426. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Zhang, M. H Gail, Y.-q. Wang, L. M. Brown, K.-f. Pan, J.-l. Ma, H. Amagase, W.-c. You, and R. Moslehi A randomized factorial study of the effects of long-term garlic and micronutrient supplementation and of 2-wk antibiotic treatment for Helicobacter pylori infection on serum cholesterol and lipoproteins. Am. J. Clinical Nutrition, October 1, 2006; 84(4): 912 - 919. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. pylori Eradication and Precancerous Gastric Lesions Journal Watch (General), August 8, 2006; 2006(808): 1 - 1. [Full Text]
|
|
|
|
|
|
J. A. Baron (Nutritional) chemoprevention of cancer: what's up? J Natl Cancer Inst, July 19, 2006; 98(14): 945 - 946. [Full Text] [PDF]
|
|