Upper gastrointestinal tract manifestations in primary antibody deficiencies: from Helicobacter pylori to gastric cancer.

PURPOSE OF REVIEW: Gastric cancer has emerged as a prominent cause of mortality in individuals with primary antibody deficiencies (PAD), especially common variable immunodeficiency (CVID), however its pathogenesis remains still poorly understood. Helicobacter (H.) pylori contributes to gastric cancerrisk in PAD, warranting early detection and eradication strategies. Prevention measures and screening programmes are still debated. This review provides an overview of recent advances in the field and discusses future perspectives.

RECENT FINDINGS: Over the last years, several papers have focused on the epidemiology, pathology, and treatment related to the high incidence and mortality of gastric cancer in PAD. Histological findings support the role of H. pylori as a key contributor, warranting early detection and eradication strategies. Immune dysregulation and genetic susceptibility have also been shown to contribute to the increased risk. H. pylori screening and treatment, along with endoscopic surveillance to identify premalignant and early malignant lesions, are widely recommended. In recent years, a decline in gastric cancer mortality has been observed in patients with CVID, paralleling trends in the general population, reflecting improved H. pylori management and enhanced surveillance.

SUMMARY: Gastric cancer surveillance is a priority in PAD. Further research should clarify pathogenesis, identify reliable biomarkers for risk stratification, and to define optimal surveillance strategies, ultimately improving early diagnosis and survival.