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Histologic intestinal metaplasia and endoscopic atrophy are predictors of gastric cancer development after Helicobacter pylori eradication

Published:March 16, 2016DOI:https://doi.org/10.1016/j.gie.2016.03.791

      Background and Aims

      Helicobacter pylori eradication therapy is effective at reducing the incidence of gastric cancer; however, gastric cancer still develops after eradication. We conducted a cohort study to elucidate the risk factors for gastric cancer development after successful H pylori eradication therapy.

      Methods

      From June 1998 to December 2012 we assessed histologic and endoscopic findings of gastritis and performed H pylori eradication therapy in 748 patients without a history of gastric cancer. Patients were classified according to the distribution of intestinal metaplasia (IM) as follows: no IM (IM group A), IM in the antrum only (IM group B), and IM in the corpus (IM group C). We assessed atrophy endoscopically according to the Kimura-Takemoto classification system. Gastric cancer incidence was assessed.

      Results

      A total of 573 patients underwent follow-up endoscopy; the mean duration of follow-up was 6.2 ± 4.8 years. Gastric cancer developed in 21 (20 intestinal type). The cumulative 5-year incidences of gastric cancer were 3.2% overall; 1.5%, 5.3%, and 9.8% in IM groups A, B, and C; and 0.7%, 1.9%, and 10% in the none/mild, moderate, and severe endoscopic atrophy groups, respectively. Compared with IM group A, the hazard ratio for IM group B was 3.6 (95% confidence interval [CI], 1.2-11), and that for IM group C was 3.7 (95% CI, 1.1-12). Compared with the none/mild endoscopic atrophy group, the hazard ratio for severe atrophy was 9.3 (95% CI, 1.7-174).

      Conclusions

      Patients with histologic IM or severe endoscopic atrophy were at increased risk of gastric cancer development after H pylori eradication.

      Abbreviations:

      H&E (hematoxylin and eosin), IM (intestinal metaplasia)
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      Linked Article

      • Role of endoscopic surveillance for intestinal metaplasia limited to the antrum
        Gastrointestinal EndoscopyVol. 84Issue 5
        • Preview
          The work by Shichijo et al1 showed a cumulative 5-year gastric cancer (GC) incidence of 3.2% in a cohort of 543 patients without history of GC, treated for Helicobacter pylori, and followed for 6.2 ± 4.8 years. In addition to severe endoscopic atrophy (hazard ratio [HR], 9.3) and corporal intestinal metaplasia (HR, 3.7), surprisingly, intestinal metaplasia limited to the antrum (HR, 3.6) was associated with GC development at follow-up. These data raise 2 concerns.
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