Helicobacter pylori, antioxidants and garlic in stomach cancer prevention

reference

Li WQ, Zhang Jy, Ma JL, et al. Effects of Helicobacter pylori treatment and vitamin and garlic supplement on the incidence and mortality of stomach cancer: follow-up of a randomized intervention study. bmj . 2019; 366: 15016

draft

Faded, randomized, factorial, placebo -controlled study (Shandong Intervention Trial)

objective

to determine whether the extermination of Helicobacter pylori and/or garlic and/or vitamin (vitamin E and selenium) supplementation influence the incidence or mortality of stomach cancer over a period of more than 2 decades (22.3 years)

participant

The participants are those in Shandong Intervention Trial. In 1994, 3,599 people volunteered for the study, including gastroscopy with biopsies and the provision of blood samples Helicobacter pylori . All participants came from 13 villages in Linqu, China, a region with a high incidence of stomach cancer. After all exclusion criteria were applied, a total of 3,365 participants (aged 35-64) were persecuted and evaluated.

Intervention

of the total of 3,365 participants were 2,258 seropositive for IgG antibodies Helicobacter pylori and 1,107. Each group received either a sham treatment for Helicobacter pylori or correctly Helicobacter pylori eradication treatment as well as a 2 x 2 assignment to vitamin and garlic supplementary arms. The details of the groups are as follows:

• from September 15, 1995 to November 29, 1995, the seropositive group (n = 2,258) received 1 g of amoxicillin and 20 mg omeprazole (n = 1.130) or a placebo equivalent (n = 1.128) twice a day for 2 weeks. During this time, those who were seronegative (n = 1.107) were given a placebo to maintain the masking of all participants.
• From January to March 1996, ^{13 Cure urine-fabric at tests showed that 382 participants were still seropositive, and these participants received additional two-week treatment with amoxicillin and omeprazole. In order to maintain the masking of the participants, 383 participants were compared according to gender, village and age and received a placebo treatment.}
• from November 30, 1995 to March 31, 2003, all participants (n = 3,365) received a randomized randomized either a vitamin capsule (n = 1,677) or an identical looking placebo (n = 1,688). Each capsule of the vitamin preparation contained 250 mg vitamin C, 100 IE vitamin E and 37.5 µg selenium.
• from November 30, 1995 to March 31, 2003, all participants (n = 3,365) were selected according to the random principle to take 1 capsule garlic supplement or placebo twice a day. The garlic preparation (used brand: Waukanuga) contained 200 mg aged gone blue extract and 1 mg steam -distilled garlic oil per capsule. Placebo bottles contained tiny amounts of garlic oil to mask the assignment.

The patient's compliance was considered excellent, whereby the tracking of the dietary supplement was taken by pills in monthly visits for 7.3 years of the nutritional supplement. All additions and placebos were completed on March 31, 2003. Records on stomach cancer incidence and causes of death for the study participants continued during the 22.3 year after-observation period, which ended on December 1, 2017.

parameter evaluated

The primary endpoint was the incidence and mortality of stomach cancer in the course of the study (22.3 years). The authors suspect incidence due to planned gastroscopies and active clinical aftercare. They determined the mortality of official records caused by stomach cancer, including death certificates and hospital documents.

Secondary endpoints included other causes of death, including other types of cancer and cardiovascular diseases.

result

Primary endpoint: From 1995 to 2017 there were 151 cases of stomach cancer and 94 deaths due to the illness.

important knowledge

All 3 interventions were associated with a significant reduction in stomach cancer mortality. The adjusted hazard ratios were 0.62 (95 % KI; 0.39-0.99) for Helicobacter pylori extermination, 0.48 (0.31–0.75) for the vitamin supplement and 0.66 (0.43–1.00) for the garlic supplement.

In this analysis, 22.3 years after the randomization of the participants, Helicobacter pylori eradication led to reduced incidence, vitamin supplement led to reduced incidence and garlic supplement, no statistical significance in relation to the incidence of stomach cancer.

In terms of secondary endpoints, there were no measurable effects between interventions and other types of cancer or cardiovascular diseases in this study.

Comment

stomach cancer is the most fifth-frequent type of cancer and the third most common cause of cancer after lung and colon cancer. ^{1 worldwide is very different depending on the culture and region, whereby the highest incidence rates in East and Central Asia and Latin America are recorded. In North America, the incidence of 5.6/100,000 of the population is relatively low.}

The overall incidence of stomach cancer is declining, even before the introduction of Helicobacter-Pylori extermination. In particular, non-Kardia stomach cancer, which affects the lower part of the stomach, is declining. It is believed that this is due to changes in hygiene, food preservation techniques and better availability of fresh fruit and vegetables. ^{3 Finally extermination of Helicobacter pylori which is associated with atrophic gastritis and a higher risk of stomach cancer Non-Kardia stomach cancer.}

While the incidence of non-Kardia stomach cancer has decreased, cardia stomach cancer, the esophageal cancer is similar, has sifted. The reasons for this are unclear, but central obesity with subsequent hiatus hernia and reflux are implied. ^{4 In addition, Kardia stomach cancer is often not Helicobacter-pylori}

The Shandong intervention study began in 1994 and was a continuous study with several times of tracking to evaluate the temporal effects of the interventions. ^{5 This study is also a groundbreaking study in oncology that shows for the first time that the eradiation of helicobacter pylori of stomach cancer. 6.7 The extermination of Helicobacter-pylori is today a recognized strategy for reducing stomach cancer risks worldwide. 8 continue to determine the best ways to create community-wide programs in order to reduce the occurrence of stomach cancer Helicobacter-pylori Exhaling. 9.10}

Two earlier times used for the data analysis of the Shandong study were 7.3 years after the randomization and 14.7 years after randomization. The current study took place 22.3 years after the randomization. The data from all of these have created a temporal perspective of the interventions used in the study. A central result of this study is confirmation that the extermination of Helicobacter pylori With a treatment duration of only 2-4 weeks, both the incidence and the mortality of stomach cancer significantly reduce in the following 20+ years.

A vitamin supplement tends to lead to a lower incidence and mortality of stomach cancer, but did not achieve statistically significant reduction in incidence and mortality up to 22.3 years. A garlic supplement never achieved a statistically significant reduction in stomach cancer incidence, but after 22.3 years, garlic led to a statistically significant reduction in stomach cancer mortality. This indicates that a temporary treatment with vitamins or garlic (7.3 years, from 1995 to 2003) influenced the incidence and mortality of stomach cancer more than 2 decades later.

restrictions

Data on self-prescribed or medically prescribed treatments, including Helicobacter-pylori -were no longer pursued after 2003. Lifestyle, nutrition and intake of nutritional supplements were also no longer followed after 2003, it is unlikely that they will change the results.

It was known that this population had a lack of nutrients, especially vitamin C and selenium, 2 of the nutrients in the vitamin supplement. However, since more than the daily requirement has been administered as a dietary supplement, it is unclear whether it is a satiety or dose-dependent effect of the vitamins, which played a role in reducing the incidence and mortality of stomach cancer. It cannot be determined whether the addition of these nutrients benefits from those that have no shortage.

As so often, the authors conclude that further studies have to be carried out before one of the therapeutic interventions is adopted into community medicine. However, it is clinically difficult to justify that patients are not supplied with vitamin C, selenium and vitamin E and at the same time enjoy garlic in their diet. Once again, we have the reason to promote the introduction of a strongly herbal diet, with another study indicated that the allium garlic in particular is useful. While further studies are carried out, we can be confident that these overall health -promoting advice will serve the patient well and may even reduce their risk of developing stomach cancer or die.