Eradication of Helicobacter pylori in the Primary Prevention of Gastric Cancer: A Systematic Review and Meta-Analysis

<i>Helicobacter</i> infection is the main modifiable risk factor for gastric cancer, especially in regions with intermediate to high incidence. Although <i>Helicobacter pylori</i> eradication has been shown to have a potential preventive effect, its magnitude remains a subject of debate due to methodological differences between clinical trials. We conducted a systematic review and meta-analysis, prospectively registered in PROSPERO (CRD420251181762), to evaluate the effect of <i>H. pylori</i> eradication on the incidence of gastric cancer in asymptomatic adults. A systematic search of major databases was conducted through November 2025, including randomized clinical trials that compared eradication therapy with control interventions. In most of the included studies, eradication therapy was consistently associated with a reduction in gastric cancer incidence, with moderate variability between trials. Sensitivity analyses supported the robustness of this association, while no clear effect on gastric cancer-specific mortality was observed. Our findings suggest that <i>H. pylori</i> eradication represents an effective strategy for the primary prevention of gastric cancer in populations at intermediate to high risk of developing the disease.