Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.692
Peer-review started: October 29, 2022
First decision: November 14, 2022
Revised: November 28, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: January 28, 2023
Processing time: 83 Days and 11.5 Hours
Helicobacter pylori (H. pylori) infection is a risk factor for many diseases, including peptic ulcer disease and gastric cancer. While H. pylori eradication therapy can prevent these diseases, potentially unfavorable effects of eradication therapy have also been reported in some diseases, such as gastroesophageal reflux disease (GERD), Barrett’s esophagus (BE), inflammatory bowel disease (IBD), allergic diseases, and metabolic diseases. Consequently, both positive and negative impacts should be considered when assessing the effects of H. pylori eradication therapy.
To compare the incidence of these diseases before and after H. pylori eradication and to comprehensively assess its effects.
This retrospective cohort study used a Japanese nationwide health claims database (April 2009-March 2020), developed by the Japanese Ministry of Health, Labour and Welfare. The database contained almost all health insurance claims data issued in Japan, and specific health check-up data for individuals who took the check-ups. Descriptive statistics were used for the analyses. Patients who received primary eradication therapy were defined as those prescribed medi-cation for H. pylori eradication. New diagnoses, defined as incidence of upper gastrointestinal diseases and IBD, and prevalence of allergic diseases were compared before and after eradication. The incidence and prevalence of each disease were also compared between the 3-year period before eradication (from the 4th to the 2nd year prior to the year of eradication) and the 3-year period after eradication (from the 1st to the 3rd year after the year of eradication) based on the age category and calendar year and month. Changes in body mass index and proportion of patients with metabolic syndrome (MS) were examined before and after eradication.
We identified 5219731 patients who received primary eradication therapy. The 65-69 years age group had the greatest number of patients in both sexes. There was no significant increase in the incidence of GERD after eradication when considering the effects of aging and reporting period. However, the incidence of BE was higher in the 3-year period after eradication than in the 3-year period before eradication for all age categories (0.02%-0.10% vs < 0.01%-0.05%). The incidence of IBD and prevalence of allergic disease were also higher after eradication. In contrast, the incidence of gastric and duodenal ulcers and gastritis was reduced after eradication. In patients with at least one entry of health check-up data (1701111 patients), the percentage of patients with MS showed a slight increase following eradication (11.0% in the year of eradication and 12.2% after 5 years).
The results suggest that H. pylori eradication therapy reduces peptic ulcers and gastritis; however, it is associated with increased incidence of several other chronic diseases.
Core Tip: While Helicobacter pylori (H. pylori) eradication can prevent certain diseases including peptic ulcer diseases and gastric cancer, unfavorable effects of eradication therapy have also been reported. We analyzed a Japanese nationwide health claims database containing almost all health insurance claims data to compare the incidence and prevalence of specific diseases before and after H. pylori eradication to comprehensively assess its effects. We identified 5219731 patients who received primary eradication therapy. H. pylori eradication drastically reduced peptic ulcers and gastritis but was associated with an increase in Barrett’s esophagus, inflammatory bowel disease, allergic disease, and metabolic syndrome.