Chemoprevention strategies for precancerous gastric lesions beyond Helicobacter pylori eradication

Gastric cancer (GC) is a significant global health challenge, particularly in high-incidence regions like East Asia. Despite improvements in screening and treatment, the progressive nature of precancerous lesions-such as atrophic gastritis, intestinal metaplasia and dysplasia-necessitates effective prevention strategies. This review evaluates the role of chemoprevention in GC, focusing on agents designed to target these precancerous lesions. The interventions examined include nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, antioxidants, vitamins, folic acid, bioactive compounds, traditional herbal medicines and emerging agents like metformin. Additionally, the potential of oxygen radical scavengers, anti-inflammatory agents and pathway-specific inhibitors is explored. While promising, the clinical effectiveness of these agents varies, and significant challenges remain in translating preclinical successes into clinical practice. Large-scale clinical trials are essential to validate these strategies and determine their role in GC prevention, particularly for high-risk populations. Integrating chemoprevention with existing GC management protocols may offer a more comprehensive approach to reducing GC incidence and improving outcomes.