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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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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