Infection with H pylori leads to a persistent chronic inflammation of the gastric mucosa, thereby increasing the risk of distal gastric adenocarcinoma. Numerous studies have determined a clear correlation between H pylori infection and the risk of gastric cancer; however, general eradication is not recommended as cancer prophylaxis and time points for treatment remain controversial in different areas of the world. Prevalence rates in Western countries are decreasing, especially in younger people (< 10%); and a decline in distal gastric adenocarcinoma has been observed. Risk groups in Western countries still show considerably higher risk of developing cancer, especially in patients infected with cagA+ strains and in persons harboring genetic polymorphism of the IL-1B promoter (-511T/T) and the corresponding IL-1 receptor antagonist (IL-1RN*2). Thus, general eradication of all infected persons in Western countries not recommended and is limited to risk groups in order to achieve a risk reduction. In contrast, infection rates and cancer prevalence are still high in East Asian countries. A prevention strategy to treat infected persons may avoid the development of gastric cancer to a large extent and with enormous clinical importance. However, studies in China and Japan indicate that prevention of gastric cancer is effective only in those patients that do not display severe histological changes such as atrophy and intestinal metaplasia. Thus, prophylactic strategies to prevent gastric cancer in high risk populations such as China should therefore especially aim at individuals now at younger age when the histological alterations caused by the bacterial infection was still reversible. In countries with a low prevalence of gastric cancer, risk groups carrying cagA+ strains and IL-1 genetic polymorphisms should be identified and treated.

译文

幽门螺杆菌感染导致胃粘膜持续性慢性炎症,从而增加了远端胃腺癌的风险。大量研究已确定幽门螺杆菌感染与胃癌风险之间存在明显的相关性。但是,不建议普遍根除,因为在世界不同地区,癌症的预防和治疗时间仍然存在争议。西方国家的患病率正在下降,尤其是在年轻人中(<10%);并且已经观察到远端胃腺癌的下降。西方国家的风险人群仍然显示出较高的患癌风险,尤其是在感染cagA株的患者以及具有IL-1B启动子(-511T / T)和相应的IL-1受体拮抗剂(IL- 1RN * 2)。因此,不建议在西方国家全面消灭所有感染者,并且仅限于风险人群,以实现降低风险的目的。相反,东亚国家的感染率和癌症患病率仍然很高。治疗感染者的预防策略可以在很大程度上避免胃癌的发展,并且具有巨大的临床意义。但是,在中国和日本的研究表明,胃癌的预防仅对那些没有表现出严重的组织学改变(例如萎缩和肠化生)的患者有效。因此,在中国这样的高风险人群中,预防胃癌的预防策略应特别针对年龄较小的人群,因为这些年龄段的细菌感染引起的组织学改变仍然是可逆的。在胃癌患病率较低的国家,应识别和治疗携带cagA毒株和IL-1遗传多态性的危险人群。

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