CONFERENCE
Those 647 residents who participated in the first phase of the study, which took place in 2016, will be invited for a follow-up examination. With the aim of discovering and proving the effectiveness of new screening methods for the early detection and prevention of stomach and intestinal cancers in regions with high cancer prevalence, the GISTAR study (Gastric cancer prevention study by predicting atrophic gastritis) was initiated in October 2013. By the end of the inclusion period in 2023, 11,223 residents of Latvia had participated. This unique study in Europe, which takes place only in Latvia and is one of the longest and most comprehensive in Latvian medicine, is conducted by the Institute of Clinical and Preventive Medicine of the University of Latvia (LU KPMI) under the leadership of Professor and gastroenterologist Mārčs Leja. GISTAR study participants who were found to have the bacteria H. pylori in their stomach received a treatment course for its eradication. Currently, a follow-up survey of participants is being conducted, which will continue until February 2026. Invitations for follow-up visits have been completed in Cēsis (332 participants), Alūksne (331 participants), Ludza (546 participants), Saldus (548 participants), Rēzekne (1111 participants), and Jēkabpils (534 participants). In September, the survey of participants in Kuldīga is also planned to begin.
Some participants in the GISTAR study had received a treatment course for the eradication of H. pylori – now a specially designed breath test is being conducted at the research centers to determine whether the eradication of the bacteria has been successful, as H. pylori is considered one of the causes of stomach cancer. Blood tests have been taken from all participants, in which various inflammation and metabolism-related parameters are planned to be determined. These tests will also be performed on samples taken from participants nine years ago and stored frozen in the laboratory. The results of the old and new tests will be compared. It will be investigated whether there is any correlation between changes in the tests and health-related events with the use of H. pylori eradication medications.
All participants were offered to perform a fecal immunochemical test to determine the presence of hidden blood in the stool, and those with a positive test were advised to undergo a colonoscopy, or examination of the large intestine. During this examination, polyps can be detected, the removal of which reduces the risk of developing colorectal cancer.
Researcher, gastroenterologist Dr. med Danute Ražuka-Ebela from the Institute of Clinical and Preventive Medicine at the University of Latvia emphasized that there is currently a lack of effective stomach cancer screening methods in Europe, which makes the GISTAR study unique not only in Latvia but also on a European scale: “It seeks new strategies to reduce stomach cancer mortality in high-risk areas, including Latvia. Previous studies indicate that the eradication of the bacteria H. pylori, which resides in the stomach and promotes the development of stomach cancer, could reduce the number of deaths caused by stomach cancer by up to 40%. Therefore, it is crucial to find ways to implement this prevention in practice.”
"In absolute numbers, the total number of newly diagnosed stomach cancer cases in Europe is increasing, and the Council of the European Union has recommended implementing screening programs in regions with high incidence and mortality. Latvia fully aligns with such unfavorable statistics. However, there are still no organized stomach cancer screening programs established in Europe. Although there are several ways to reduce the burden of stomach cancer, it currently seems that the 'search and treat' strategy for Helicobacter (H.pylori) infection may be the most suitable for Europe. Currently, projects such as GISTAR, EUROHELICAN, TOGAS, and EUCanScreen are expected to provide the necessary evidence on which methods are best to reduce the risk of stomach cancer. The results obtained will be significant not only for Latvia but also for other European countries with similar statistics, as well as countries outside Europe. We already know that not only in Europe but also globally, the GISTAR study data will provide significant new information," emphasized Professor Mārcis Leja.
The data obtained in the GISTAR study are also used in other studies:
TOGAS (Towards Gastric Screening implementation in the European Union);
EUROHELICAN (Accelerating gastric cancer reduction in Europe through Helicobacter pylori eradication);
EUCanScreen (European Joint Action on Cancer Screening).
Before the opening of the GISTAR center in Tukums, training was held for its employees, during which new employees were introduced to the research website, data usage and security regulations, the GISTAR data management system, the research protocol, the inclusion criteria for research participants, and practiced standard procedures.
The leading researcher of LU KPMI, Dr.sc.ing. Sergejs Paršutins, introduced the center's employees to data entry systems, security regulations, and data storage conditions, while LU KPMI senior expert Aiga Rūdule informed about the special project requirements, expected results, and quality control, as well as the design, goals, and objectives of the GISTAR study.
A lecture on the possibilities of reducing mortality caused by stomach cancer and the European perspective on these issues was delivered by the scientific leader of the GISTAR study, LU KPMI director, gastroenterologist, and professor at the University of Latvia, Mārcis Leja.
The project "Towards Gastric Cancer Screening Implementation in the European Union" (TOGAS) has received funding from the European Union program EU4Health under grant agreement No. 101101252.
The views and opinions expressed here reflect only the author's perspective and do not represent the position of the European Union or the European Health and Digital Executive Agency (HaDEA). The European Union and the funding body bear no responsibility for them.
