Clinical Aspects of Gastric Cancer and Helicobacter pylori – Screening, Prevention, and Treatment Michael Selgrad,* Jan Bornschein,* Theodore Rokkas † and Peter Malfertheiner* *Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany, † Gastroenterology Clinic, Henry Dunant Hospital, 192B Alexandras Avenue, Athens, Greece Gastric cancer (GC) still ranks as the second most fre- quent cancer worldwide with around one million new diagnoses each year [1]. In spite of our improved understanding of gastric carcinogenesis and much new effort in prevention strategies, the 5-year survival rate is only 10–15% in patients with advanced disease [2]. Thus, prevention, early diagnosis, and adequate surgery remain the pivotal components in the battle against GC. In the advanced stage of the disease, established and new neoadjuvant, adjuvant, and palliative chemo- therapy- or radiotherapy-based strategies improve the survival rates and will have a significant role in the future. Although the incidence of GC differs between conti- nents, the infection with Helicobacter pylori is the most important risk factor in all geographic areas and H. pylori infection carries the same risk for both histo- logic types of GC, the intestinal and diffuse type [3]. Several studies in the last year have gained further evidence that eradication of the bacteria is one of the most promising preventive strategies in the fight against GC. Furthermore, serologic-based tests as screening mark- ers for preneoplastic changes of the gastric mucosa have the potential for the early detection of gastric mucosal changes with risk of GC or to identify patients who are at high risk that require a close clinical follow- up. This review gives a brief overview about the achieve- ments in prevention, screening, and clinical manage- ment of GC that have been published between April 2009 and May 2010. Screening Population-based screening most likely represents the current best option for the primary prevention of GC. But large differences in incidence exist between popula- tions, mainly attributable to differences in the H. pylori CagA status and dietary factors [4]. During the last dec- ades, serologic screening has been implemented in countries at high risk of GC, such as Japan. The infec- tion with H. pylori and consequent atrophic gastritis are regarded as the main risk factors for GC development [5]. To predict the risk of GC development and to diag- nose atrophic gastritis, serologic testing for a combina- tion of pepsinogen (PG) I and II, and gastrin and H. pylori antibodies has yielded accurate results over the last years [6,7]. A recent study confirmed the useful- ness of the combination of serum anti-H. pylori-(IgG) antibodies and PG measurement to identify high-risk groups for GC [8]. However, the same group also com- pared the PG test with the conventional X-ray exami- nation and demonstrated that the PG test alone is not appropriate for GC screening [9]. On the other hand, Miki et al. presented their long-term results of GC Keywords Chemotherapy, new drugs, eradication. Reprint requests to: Prof., Dr. med., Dr. h.c., Peter Malfertheiner, Department of Gastroen- terology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany. E-mail: peter.malfertheiner@ med.ovgu.de Abstract Gastric cancer still represents a global health care burden, and in the absence of strategies implemented for early detection, the disease continues to have a dismal prognosis. Patients presenting with clinical manifestations of gastric cancer have limited options for cure. Thus, early detection and prevention play a key role in the fight against gastric cancer. Serologic-based test methods have the potential to detect a subset of patients at high risk of gastric cancer that require a close clinical and endoscopic follow-up. More data have been produced to support Helicobacter pylori eradication as an effi- cient strategy to prevent gastric cancer. Treatment options for patients with an advanced disease are still limited, but the introduction of new agents opens a more optimistic perspective for the future. Helicobacter ISSN 1523-5378 40 ª 2010 Blackwell Publishing Ltd, Helicobacter 15 (Suppl. 1): 40–45