Stomach cancer primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

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Overview

Effective measures for the primary prevention of stomach cancer include smoking cessation, helicobacter pylori infection eradication, and having a balanced diet rich in fruits and vegetables.

Primary prevention

H.pylori eradication

  • Recent meta-analyses have each found that the incidence of metachronous gastric cancer following the endoscopic resection of a gastric neoplasm was reduced by the eradication of H. pylori infection ( 31–33 ).
  • Most recently, a meta-analysis comprising 24 studies (22 out of which were conducted in Asia) confirmed a lower rate of metachronous EGC following treatment of H. pylori infection; the incidence rate ratio was 0.54 (95% CI 0.46–0.65) ( 34 ).

Recommended first-line therapies for H pylori infection:

Regimen Drug dose Dosing frequency Duration(days) FDA approval
Clarithromycin triple PPI(standard or double dose

Clarithromycin(500mg)

Amoxicillin(1gm)or Metronidazole(500mg TID)

BID 14 days YES
Bismuth Quadruple PPI(standard dose)

Bismuth subcitrate (120-300mg)or Subsalicylate (300mg)

Tetracyclin(500mg)

Metronidazole(250-500mg)

BID

QID

QID

TID to QID (500mg)

10-14 days NO
Concomitant PPI (standard dose)

Clarithromycin (500mg)

Amoxicillin(1gm)

Nitroimidazole(500mg)c

BID 10 -14 days NO
Sequential PPI(standard dose)+Amoxicillin(1gm)

PPI,Clarithromycin(500mg)+Nitroimidazole(500mg)c

BID

BID

5-7 days

5-7 days

NO
Hybrid PPI(standard)+Amoxicillin(1gm)

PPI,Amoxicillin,Clarithromycin(500mg),Nitroimidazole(500mg)c

BID

BID

7 days

7 days

NO
Levofloxacin triple PPI(standard dose)

Levofloxacin(500mg)

Amoxicillin(1gm)

BID

QID

BID

10-14 days NO
Levofloxacin sequential PPI(standard or double dose)+Amoxicillin(1 gm)

PPI,Amoxicillin,Levofloxacin(500mg QD),Nitroimidazole(500mg)c

BID

BID

5-7 days NO
LOAD Levofloxacin(250mg)

PPI(double dose)

Nitazoxanide(500mg)c

Doxycycline(100mg)

QD

QD

BID

QD

7-10 days NO
: Several PPI, Clarithromycin, and Amoxicillin combinations have achieved FDA approval, PPI, Clarithromycin, Metronidazole are not an FDA approved treatment regimen.

‡: PPI, Bismuth, Tetracycline, and metronidazole prescribed separately are not an FDA approved treatment regimen. However, Pylera, a combination product containing Bismuth subcitrate, Tetracycline, Metronidazole combination with PPI for 10 days is an FDA approved regimen.

  • BID, twice daily; FDA, Food and Drug Administration; PPI, proton pump inhibitor; TID, three times daily; QD, once daily; QID, four times daily.

c:Metronidazole or Tinidazole[1]

After the failure of first-line therapy, such patients should be considered for referral for salvage treatment.

Salvage therapies for Helicobacter pylori infection
Regimen Drugs(doses) Dosing frequency Duration(days) FDA approval
Bismuth quadruple
  • PPI(standard dose)
  • Bismuth subciitrate 120-300mg or sub salicylate 300mg
  • Tetracycline 500mg
  • Metronidazole 500mg
BID

QID

QID

TID or QID

14 NO(a)
Levofloxacin triple
  • PPI(standard dose)
  • Levofloxacin 500mg
  • Amoxicillin 1gm
BID

QD

BID

14 NO
Concomitant
  • PPI(standard dose)
  • Clarithromycin 500mg
  • Amoxicillin 1gm
  • Nitroimidazole 500mg
BID

BID

BID

BID or TID

10-14 NO
Rifabutin triple
  • PPI(standard dose)
  • Rifabutin 300mg
  • Amoxicillin 1gm
BID

QD

BID

10 NO
High-dose dual
  • PPI(standard to double dose)
  • Amoxicillin 1gm TID or 750mg QID
TID or QID

TID or QID

14 NO

(a)PPI,Bismuth,tetracyclin and metronidazole prescribed separately is not an FDA-approved treatment regimen.However,Pylera,a combination product containing bimuth subcitrate,tetracyclin and metronidazole combined with a PPI for 10 days is an FDA-approved treatment regimen.

  • BID, twice daily; FDA, Food and Drug Administration; PPI, proton pump inhibitor; TID, three times daily; QD, once daily; QID, four times daily[1].

References

  1. 1.0 1.1 "www.nature.com" (PDF).

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