Helicobacter pylori eradication reduces gastric cancer risk, but the long-term impact in peptic ulcer patients, particularly those with gastric ulcers (GU), remains unclear. To assess the long-term incidence of gastric cancer in patients with H. pylori-treated gastric ulcers compared to the general population and to patients with duodenal ulcers (DU). Using Korea's National Health Insurance Service database, we identified patients aged ≥ 40 years with endoscopically and histologically confirmed peptic ulcers treated for H. pylori between 2005 and 2008. Follow-up continued until 2019. Standardized incidence ratios (SIRs) for gastric cancer were calculated by comparing incidence in the study cohorts with the age- and sex-matched general population. Among 166,260 eligible patients (median follow-up 9.2 years), 2630 (1.58%) developed gastric cancer (SIR, 1.20; 95% CI, 1.15-1.24; p < 0.001), with consistently elevated risks across all age groups. Although cancer incidence remained elevated up to 12 years, patients followed for ≥ 13 years exhibited a significantly reduced risk compared to the general population (SIR, 0.78; 95% CI, 0.60-0.99; p = 0.049). In a sensitivity analysis, duodenal ulcer patients (n = 46,602) showed a lower overall risk (SIR, 0.86; 95% CI, 0.78-0.94; p < 0.001), with significant reductions even before 13 years of follow-up. Gastric ulcer patients remain at increased risk for gastric cancer following H. pylori treatment. However, this risk declines over time and may fall below that of the general population after 13 years. These findings support the need for long-term surveillance in this high-risk group.

Helicobacter pylori (HP) infection has been linked to systemic inflammation and vascular dysfunction, potentially contributing to arterial stiffness. Research in younger populations is limited, highlighting the need to explore its early cardiovascular impact. This study investigated the association between histologically confirmed HP infection and arterial stiffness. Data were retrospectively analyzed from a cohort of adults who underwent health check-ups and gastric mucosal biopsies to confirm HP infection. A mong them, young adults aged 19-39 years were included in the analysis. Arterial stiffness was assessed using estimated PWV (ePWV), which was calculated using age and mean arterial pressure according to validated equations. Among 7803 participants, 4289 (53.9%) tested positive for HP. ePWV was significantly higher in HP-positive individuals (6.66 ± 0.60 vs. 6.33 ± 0.58 m/s; p < 0.001), with a linear increase observed across HP severity levels (analysis of variaungnce p < 0.01). A positive correlation was identified between the Updated Sydney System (USS) score and ePWV (p < 0.001). Multiple linear regression analysis demonstrated an independent association between USS score and ePWV after adjusting for confounders. Logistic regression analysis showed that severe HP infection was associated with a markedly higher likelihood of elevated ePWV (odds ratio, 3.87; 95% CI. 3.25-4.60; p < 0.001). HP infection was independently associated with increased arterial stiffness in young adualts, with greater infection severity linked to higher ePWV levels. Early detection may help reduce long-term cardiovascular risk.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Recent American College of Gastroenterology (ACG) guidelines recommend screening and eradicating Helicobacter pylori (H. pylori) in high-risk racial groups to prevent gastric cancer (GC), but do not provide guidance on the age to screen. We aimed to determine the optimal age for H. pylori screen-and-treat. We developed a new microsimulation model, MISCAN-gastric, which was calibrated to SEER incidence and clinical studies on the natural history of GC. One-time screen-and-treat at ages 20-65 was compared to a no-screening scenario in terms of cumulative incidence reduction, number needed-to-screen (NNS) and number needed-to-treat (NNT) to prevent one GC case. The NNS represents the number of individuals that require testing to prevent one GC case, while the NNT reflects the number requiring treatment. The optimal age was investigated for a high-risk population subgroup (non-Hispanic [NH] Black males) and compared to other subgroups. Without screening, 332 noncardia GC cases occurred in a population of 100,000 NH Black males. H. pylori screen-and-treat reduced cumulative incidence by 43% when performed at age 20, but only by 5% when performed at age 65. The NNS was lowest at age 30 and increased markedly at older ages. The estimated NNS for test-ages 20, 30, 40, and 65 were 645, 563, 769, and 5487, respectively. The NNT was lowest at the youngest age (261) and increased with age to 448 at age 40 and 3681 at age 65. The NNT and NNS were substantially higher in groups with lower GC risk: the optimal NNT was four times higher in NH White females compared to non-Hispanic Black males. H. pylori screen-and-treat maximized population benefits when performed before age 40, emphasizing the need for early interventions. When performed at the optimal age, the benefits of H. pylori screen-and-treat may outweigh the harms for high-risk racial groups.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.