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)To read this article in full you will need to make a payment
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References
- Helicobacter pylori and gastric carcinogenesis.Am J Surg Pathol. 1995; 19: S37-S43
- Carcinogenesis of Helicobacter pylori.Gastroenterology. 2007; 133: 659-672
- Seventeen-year effects of eradicating Helicobacter pylori on the prevention of gastric cancer in patients with peptic ulcer; a prospective cohort study.J Gastroenterol. 2015; 50: 638-644
- Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials.BMJ. 2014; 348: g3174
- Effect of Helicobacter pylori eradication on metachronous gastric cancer after endoscopic resection of gastric tumors: a meta-analysis.Helicobacter. 2014; 19: 243-248
- Group JGS. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial.Lancet. 2008; 372: 392-397
- The effect of Helicobacter pylori eradication on reducing the incidence of gastric cancer.J Clin Gastroenterol. 2008; 42: 279-283
- Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer?.Ann Intern Med. 2009; 151: 121-128
- Eradication of Helicobacter pylori prevents cancer development in subjects with mild gastric atrophy identified by serum pepsinogen levels.Int J Cancer. 2009; 125: 2697-2703
- Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial.JAMA. 2004; 291: 187-194
- Helicobacter pylori eradication and gastric cancer: when is the horse out of the barn?.Am J Gastroenterol. 2009; 104: 1342-1345
- Preventing metachronous gastric lesion after endoscopic submucosal dissection through Helicobacter pylori eradication.J Gastroenterol Hepatol. 2015; 30: 75-81
- Gastric cancer risk according to the distribution of intestinal metaplasia and neutrophil infiltration.J Gastroenterol Hepatol. 2011; 26: 1570-1575
- Helicobacter pylori infection and the development of gastric cancer.N Engl J Med. 2001; 345: 784-789
- Histologic and serum risk markers for noncardia early gastric cancer.Int J Cancer. 2005; 115: 463-469
- Helicobacter pylori infection and the risk of gastric malignancy.Am J Gastroenterol. 2007; 102: 725-730
- Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands.Gastroenterology. 2008; 134: 945-952
- Topographic patterns of intestinal metaplasia and gastric cancer.Am J Gastroenterol. 2000; 95: 1431-1438
- The distribution of intestinal metaplasia as a predictor of gastric cancer development.J Gastroenterol Hepatol. 2015; 30: 1260-1264
- Predictive factors for metachronous gastric cancer in high-risk patients after successful Helicobacter pylori eradication.Digestion. 2008; 78: 113-119
- Autofluorescence imaging for predicting development of metachronous gastric cancer after Helicobacter pylori eradication.J Gastroenterol Hepatol. 2010; 25: 1844-1849
- An endoscopic recognition of the atrophic border and its signifiance in chronic gastritis.Endoscopy. 1969; 3: 87-97
- Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease.Gastroenterology. 2009; 137: 1641-1648.e1-2
- Gastritis staging in clinical practice: the OLGA staging system.Gut. 2007; 56: 631-636
- Gastritis OLGA-staging and gastric cancer risk: a twelve-year clinico-pathological follow-up study.Aliment Pharmacol Ther. 2010; 31: 1104-1111
- The severity of endoscopic gastric atrophy could help to predict Operative Link on Gastritis Assessment gastritis stage.J Gastroenterol Hepatol. 2011; 26: 281-285
- Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis.Digestion. 2011; 83: 253-260
- The long-term impact of Helicobacter pylori eradication on gastric histology: a systematic review and meta-analysis.Helicobacter. 2007; 12: 32-38
- Ten-year prospective follow-up of histological changes at five points on the gastric mucosa as recommended by the updated Sydney system after Helicobacter pylori eradication.J Gastroenterol. 2012; 47: 394-403
- Helicobacter pylori eradication therapy improves atrophic gastritis and intestinal metaplasia: a 5-year prospective study of patients with atrophic gastritis.Aliment Pharmacol Ther. 2002; 16: 1449-1456
- Histological changes of gastric mucosa after Helicobacter pylori eradication: a systematic review and meta-analysis.World J Gastroenterol. 2014; 20: 5903-5911
- The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis.Gastrointest Endosc. 2010; 71: 1150-1158
- Follow-up of premalignant lesions in patients at risk for progression to gastric cancer.Endoscopy. 2013; 45: 249-256
- Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?.World J Gastroenterol. 2009; 15: 4290-4297
- Helicobacter pylori eradication reduced the incidence of gastric cancer, especially of the intestinal type.Aliment Pharmacol Ther. 2007; 25: 805-812
- Gastric cancer pathology and underlying molecular mechanisms.Dig Surg. 2013; 30: 150-158
Mori G, Nakajima T, Asada K, et al. Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan. Gastric Cancer. Epub 2015 Sep 29.
- Eradication of Helicobacter pylori reduces metachronous gastric cancer after endoscopic resection of early gastric cancer.Hepatogastroenterology. 2013; 60: 776-780
- Basis of decreased risk of gastric cancer in severe atrophic gastritis with eradication of Helicobacter pylori.Dig Dis Sci. 2007; 52: 232-239
- A follow-up study on the effect of Helicobacter pylori eradication on the severity of gastric histology.Dig Dis Sci. 2005; 50: 1517-1522
- Relationship between nuclear factor-kappaB activation and virulence factors of Helicobacter pylori in Japanese clinical isolates.J Gastroenterol Hepatol. 2002; 17: 556-562
- Determination of Helicobacter pylori virulence by simple gene analysis of the cag pathogenicity island.Clin Diagn Lab Immunol. 2001; 8: 181-186
Article Info
Publication History
Published online: March 16, 2016
Accepted:
March 4,
2016
Received:
October 28,
2015
Footnotes
DISCLOSURE: This work was supported in part by the Japan Society for the Promotion of Science KAKENHI (grant 26460934) and a grant from Daiwa Securities Health Foundation to Yoshihiro Hirata. All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Hirata at [email protected] .
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Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Role of endoscopic surveillance for intestinal metaplasia limited to the antrumGastrointestinal EndoscopyVol. 84Issue 5
- PreviewThe 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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