Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?

Mabe, Katsuhiro; Takahashi, Mikako; Oizumi, Haruhumi; Tsukuma, Hideaki; Shibata, Akiko; Fukase, Kazutoshi; Matsuda, T; Takeda, Hiroaki; Kawata, Sumio

doi:10.3748/wjg.15.4290

Cited by 50 publications

(37 citation statements)

References 13 publications

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“…Several studies have reported preventive effects of H. pylori eradication therapy against gastric cancers [1,8,9]. However, it has been clarified that primary or metachronous gastric cancers may be discovered even after successful eradication therapy [2,10].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy

2015

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Background Gastric cancer after successful Helicobacter pylori eradication therapy is often difficult to diagnose by endoscopy because of its indistinct borderline or lack of obviously cancerous characteristics. Furthermore, it has become evident that non-neoplastic epithelium covers cancerous areas in gastric cancer after eradication. Here, we investigated these endoscopic features and their relationship to histological findings. Methods We studied 24 and 47 gastric cancers in patients who had (eradication group) and had not (control group) undergone H. pylori eradication, respectively. A gastritislike appearance revealed by conventional endoscopy was defined as a mucosal pattern with no marked difference from the surrounding non-cancerous area and that revealed by narrow-band imaging (NBI)-magnifying endoscopy (ME) as the mucosal pattern observed in H. pylori-associated atrophic gastritis. We investigated a gastritis-like appearance revealed by conventional endoscopy (A), a gastritis-like appearance at the margin (B) and within (C) the cancerous area revealed by NBI-ME, and the histological characteristics of the overlying non-neoplastic epithelium. We also evaluated the relationship between endoscopic and histological findings in the eradication group. Results Endoscopy showed that features A, B and C were significantly more frequent in the eradication group (P = 0.031, P \ 0.001, P \ 0.001, respectively). Nonneoplastic epithelium covered more than 10 % of the cancerous area more frequently in the eradication group. In the eradication group, more than 90 % of cancers showing a gastritis-like appearance had non-neoplastic epithelium extending over 10 % of the cancerous area. Conclusion Gastric cancer after successful H. pylori eradication tends to have gastritis-like features due to nonneoplastic epithelium covering the cancerous tissue.

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Section: Discussionmentioning

confidence: 99%

Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy

2015

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“…Several studies have reported annual incidences of MGC after H. pylori eradication, ranging from 0.1 to 0.5 % in healthy individuals or peptic ulcer patients [26][27][28][29][30][31][32][33], and from 0.8 to 4.1 % in patients after endoscopic resection for early gastric cancer [9,[11][12][13][14][15]. Individuals after endoscopic resection had a higher risk of MGC compared with those who were healthy or had peptic ulcers.…”

Section: Discussionmentioning

confidence: 99%

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

Mori

Nakajima

Asada³

et al. 2015

Gastric Cancer

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Background A previous multicenter prospective randomized study from Japan showed that Helicobacter pylori eradication reduced the development of metachronous gastric cancer (MGC) after endoscopic resection for early gastric cancer. MGC risk, however, is not eliminated; yet few studies have evaluated its long-term incidence and risk factors. In this study, we investigated the incidence of and risk factors for MGC in patients who underwent endoscopic resection for early gastric cancer with successful H. pylori eradication. Methods A total of 594 patients who underwent endoscopic resection for early gastric cancer and successful H. pylori eradication at three institutions (National Cancer Center Hospital, University of Tokyo Hospital, and Wakayama Medical University Hospital) were analyzed retrospectively. Annual endoscopic surveillance was performed after initial endoscopic resection. MGC was defined as a gastric cancer newly detected at least 1 year after successful H. pylori eradication. Results Ninety-four MGCs were detected in 79 patients during the 4.5-year median follow-up period. KaplanMeier analysis showed the cumulative incidence of MGC 5 years after successful H. pylori eradication was 15.0 %; the incidence of MGC calculated by use of the person-year method was 29.9 cases per 1000 person-years. Multivariate analysis using the Cox proportional hazards model revealed that male sex, severe gastric mucosal atrophy, and multiple gastric cancers before successful H. pylori eradication were independent risk factors for MGC. Eleven percent of MGCs (10 of 94) were detected more than 5 years after successful H. pylori eradication. Conclusion Surveillance endoscopy for MGC in patients who have undergone endoscopic resection for early gastric cancer should be performed even after successful H. pylori eradication.

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“…Mabe et al [90] reported that cases of duodenal ulcer are more prevalent in younger individuals than gastric cancer cases and that gastritis in duodenal ulcer was primarily antral and spared the gastric corpus, allowing continued high levels of acid secretion. Corpus inflammation, however, has long been known to suppress acid, and low acid allows H. pylori to interact with the mucosa to cause more inflammation and to establish a vicious cycle leading to the loss of glands and to atrophy.…”

Section: Failure To Notice Lesionsmentioning

confidence: 99%

Why is the coexistence of gastric cancer and duodenal ulcer rare? Examination of factors related to both gastric cancer and duodenal ulcer

et al. 2011

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The coexistence of gastric cancer with duodenal ulcer has been found empirically to be rare, but why it is rare is difficult to explain satisfactorily. To elucidate this question, we carried out a literature review of the subject. The frequency with which the two diseases coexist is 0.1-1.7%, and the main factor associated with both gastric cancer and duodenal ulcer is Helicobacter pylori infection. However, there are marked differences between the disorders of hyperchlorhydria in duodenal ulcer, and hypochlorhydria in gastric cancer. The most acceptable view of the reason for the difference may be that the acquisition of H. pylori infection occurs mainly in childhood, so that the time of acquisition of atrophic gastritis may be the most important, and if atrophic gastritis is not acquired early, high levels of gastric acid may occur, and consequently acute antral gastritis and duodenal ulcer may occur in youth, whereas, in elderly individuals, persistent H. pylori infections and the early appearance of atrophic gastritis may be the causes of low gastric acid, and consequently gastric cancer may occur. In patients with duodenal ulcer, factors such as nonsteroidal anti-inflammatory drugs (NSAIDs) and dupA-H. pylori strains may contribute to preventing the early acquisition of atrophic gastritis, while acid-suppressive therapy and vascular endothelial growth factor and other entities may inhibit atrophic gastritis. In contrast, in gastric cancer, factors such as excessive salt intake, acid-suppressive therapy, polymorphisms of inflammatory cytokines, and the homB-H. pylori strain may contribute to the early acquisition of atrophic gastritis, while factors such as NSAIDs; fruits and vegetables; vitamins A, C, and E; and good nutrition may inhibit it.

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Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?

Abstract: AIM:To investigate the effects of Helicobacter pylori (H pylori ) eradication therapy for treatment of peptic ulcer on the incidence of gastric cancer.

Cited by 50 publications

References 13 publications

Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy

Endoscopic and histological features of gastric cancers after successful Helicobacter pylori eradication therapy

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

Why is the coexistence of gastric cancer and duodenal ulcer rare? Examination of factors related to both gastric cancer and duodenal ulcer

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