Samsung Medical Center
You don’t have to read this, but just to remind you that H. pylori is treatable with canadian antibiotics and typically today we use macrolides like azithromycin and bismuth compounds. And you can rid the stomach of H. pylori. This may be important in a chemo-prevention sense. In the Southwest Oncology Group we are working with a group of physicians at the Samsung Medical Center in Seoul Korea on a pilot project which is looking at a high at-risk population for gastric cancer. There is a very high incidence of gastric cancer in Korea. And randomizing patients to eradication of H. pylori and no H. pylori treatments. So this is obviously a chemo-prevention model. First we will look at whether the gastritis is significantly modified with H. pylori. The gastritis could be thought of, in a sense, as a surrogate marker for the eventual development of cancer. If this model proves to be of value – in other words, treating populations at risk with antibiotics to eradicate H. pylori – as is typical in medicine there is the law of unintended consequences. That will mean that A, a lot of people can’t afford the right antibiotics in countries where they would need them most, and B, if it is used – the antibiotic therapy is used widely – we obviously will be introducing sort of an evolutionary pressure on the bacteria to become resistant.
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What about other etiologies of gastric cancer? Prior gastrectomy is one. I’m sure most of you have not seen many patients who have had partial gastrectomies for ulcer disease in the past. Twenty-five years ago when I was training that was quite common. People did antrectomies and vagotomies and pyloroplasties to essentially decrease the gastric acid production in patients with ulcers. And it is known that there is an increased risk of gastric cancer after those procedures. The latent period is greater than 15 years. It appears that what happens is, that by decreasing … what you are doing is setting up chronic gastritis picture by decreasing the gastric acid. Now why this may be important to us is that of course the most widely prescribed, and now over-the-counter, the most widely used drugs in the pharmacopeia are H2 blockers and various ways of controlling gastric acid. And it’s possible, although we haven’t seen it yet – I’ll address it in a little bit – it’s possible that long term use – we are talking about a 15 year latency period here for gastric acid surgery – it’s possible that we will an increase in gastric cancer in people who have spent a lot of time on H2 blockers or Prilosec. So it’s something to look for in the future.
Now H2 antagonists, were thought of as, “Gee, if we make the stomach achlorhydric do we increase the risk of gastric cancer?” and short term risk has been looked at, actually. This is an article from almost ten years ago now and there was an increased risk of gastric cancer within five years of going on H2 antagonists, and the situation here was thought to be that the reason was; these patients had trouble with their stomachs, they took H2 blockers like everybody with trouble with their stomachs would. Some of the people who had trouble with their stomachs actually had premalignant conditions and had a developing gastric cancer. So people are going to watch the incidence of gastric cancer in H2 antagonists, but there is no direct connection now.
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