Helicobacter pylori Eradication Improves Gastric Atrophy and Intestinal Metaplasia in Long-Term Observation

Kodama, Masaaki; Murakami, Kazunari; Okimoto, Tadayoshi; Abe, Takashi; Nakagawa, Yoshifumi; Mizukami, Kazuhiro; Uchida, Masahiro; Inoue, Katsumi; Fujioka, Toshio

doi:10.1159/000334684

Cited by 59 publications

(45 citation statements)

References 49 publications

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“…The subjects of their study were a patient population who had moderate-to-severe atrophic mucosa accompanied by intestinal metaplasia, indicating that H. pylori eradication is effective even in patients who have advanced atrophy of the gastric mucosa. Based on long-term observation after H. pylori eradication, it has also been reported that eradicating this microorganism results in marked improvement of gastric mucosal atrophy and intestinal metaplasia, which are changes strongly related to the development of gastric cancer [25]. Therefore, it can reasonably be inferred that H. pylori eradication in cases with open-type atrophy is essential for preventing the occurrence of gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Degree of Endoscopic Atrophy of the Gastric Mucosa and Carcinogenic Risk

et al. 2015

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Background: The relationship between Helicobacter pylori infection and gastric cancer has been demonstrated, and the risk of gastric cancer occurrence is known to increase with the progression of atrophic changes associated with chronic gastritis. Endoscopic evaluation of the degree and extent of atrophy of the gastric mucosa is a simple and very important means of identifying a group at high risk for gastric cancer. This study aimed to clarify the carcinogenic risk in relation to the degree of atrophy. Methods: A total of 27,777 patients (272 with early gastric cancer and 135 with advanced gastric cancer) were included in this study. Endoscopically evaluated atrophy of the gastric mucosa was classified as C-0 to O-3 according to the Kimura and Takemoto classification system. Results: The cancer detection rate in relation to the degree of gastric mucosal atrophy was 0.04% (2/4,183 patients) for C-0, 0% (0/4,506) for C-1, 0.25% (9/3,660) for C-2, 0.71% (21/2,960) for C-3, 1.32% (75/5,684) for O-1, 3.70% (140/3,780) for O-2 and 5.33% (160/3,004) for O-3. As to the proportions of differentiated and undifferentiated cancers, the latter were relatively frequent in the C-0 to C-2 groups, but differentiated cancers became predominant as atrophy progressed. On the other hand, the number of both differentiated and undifferentiated cancers detected increased as gastric mucosal atrophy progressed. In addition, open-type atrophy was found in 29 (96.7%) of 30 patients with synchronous multiple gastric cancers and in all 20 patients with metachronous multiple gastric cancers. Conclusion: Endoscopic evaluation of gastric mucosal atrophy can provide a simple and reliable predictive index for both current and future carcinogenic risk.

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Section: Discussionmentioning

confidence: 99%

Relationship between the Degree of Endoscopic Atrophy of the Gastric Mucosa and Carcinogenic Risk

et al. 2015

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“…[51][52][53][54][55] Conversely, H pylori eradication in patients with autoimmune atrophic gastritis is followed by improved gastric acid and ascorbate secretion in many, and partial or complete remission of atrophic gastritis in a variable proportion of patients. [56][57][58][59][60] In our experience, H pylori eradication is followed by a significant decrease in serum gastrin levels in almost all patients, but complete remission accompanied by disappearance of circulating antiparietal cell antibodies (APCAs) is only observed in a limited number of patients. Failure to achieve complete remission by H pylori eradication in the majority of patients does not necessarily argue against the role of H pylori in the pathogenesis of autoimmune gastritis but more likely indicates that a point of no return may be reached beyond which the autoimmune process may no longer require the continued presence of the inducing pathogen.…”

Section: Relation Between Autoimmune Gastritis and H Pylori Infectionmentioning

confidence: 94%

“…In autoimmune gastritis patients with coexistent active H pylori infection, H pylori eradication may be useful for arresting the progress of disease and improving response to oral iron. [56][57][58][59][60] Patients with celiac disease should be started on a gluten-free diet with regular follow-up to ensure response and compliance. 67 …”

Section: Specific Treatmentmentioning

confidence: 99%

How I treat unexplained refractory iron deficiency anemia

Hershko

Camaschella

2014

Blood

140

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Endoscopic gastrointestinal workup fails to establish the cause of iron deficiency anemia (IDA) in a substantial proportion of patients. In patients referred for hematologic evaluation with unexplained or refractory IDA, screening for celiac disease, autoimmune gastritis, Helicobacter pylori, and hereditary forms of IDA is recommended. About 4% to 6% of patients with obscure refractory IDA have celiac disease, and autoimmune gastritis is encountered in 20% to 27% of patients. Stratification by age cohorts in autoimmune gastritis implies a disease presenting as IDA many years before the establishment of clinical cobalamin deficiency. Over 50% of patients with unexplained refractory IDA have active H pylori infection and, after excluding all other causes of IDA, 64% to 75% of such patients are permanently cured by H pylori eradication. In young patients with a history suggestive of hereditary iron deficiency with serum ferritin higher than expected for IDA, mutations involving iron trafficking and regulation should be considered. Recognition of the respective roles of H pylori, autoimmune gastritis, celiac disease, and genetic defects in the pathogenesis of iron deficiency should have a strong impact on the current diagnostic workup and management of unexplained, or refractory, IDA.

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“…This can be explained by the smaller number of gastric glands in the normal antral mucosa (18,152) . The results of H pylori eradication on atrophic gastritis are often controversial (38,102,111,203) . A recent meta-analysis study involving 12 trials analyzing 2,648 patients with atrophic gastritis of the antrum found no significant reversibility of atrophic changes in the antrum following H pylori eradication (203) .…”

Section: Statement 15mentioning

confidence: 99%

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

Coelho

Maguinilk

Zaterka³

et al. 2013

Arq. Gastroenterol.

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Significant progress has been obtained since the Second Brazilian Consensus Conference on Helicobacter pylori Infection held in 2004, in São Paulo, SP, Brazil, and justify a third meeting to establish updated guidelines on the current management of H. pylori infection. The Third Brazilian Consensus Conference on H pylori Infection was organized by the Brazilian Nucleus for the Study of Helicobacter, a Department of the Brazilian Federation of Gastroenterology and took place on April 12-15, 2011, in Bento Gonçalves, RS, Brazil. Thirty-one delegates coming from the five Brazilian regions and one international guest, including gastroenterologists, pathologists, epidemiologists, and pediatricians undertook the meeting. The participants were allocated in one of the five main topics of the meeting: H pylori, functional dyspepsia and diagnosis; H pylori and gastric cancer; H pylori and other associated disorders; H pylori treatment and retreatment; and, epidemiology of H pylori infection in Brazil. The results of each subgroup were submitted to a final consensus voting to all participants. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Seventy per cent and more votes were considered as acceptance for the final statement. This article presents the main recommendations and conclusions to guide Brazilian doctors involved in the management of H pylori infection.

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Helicobacter pylori Eradication Improves Gastric Atrophy and Intestinal Metaplasia in Long-Term Observation

Cited by 59 publications

References 49 publications

Relationship between the Degree of Endoscopic Atrophy of the Gastric Mucosa and Carcinogenic Risk

Relationship between the Degree of Endoscopic Atrophy of the Gastric Mucosa and Carcinogenic Risk

How I treat unexplained refractory iron deficiency anemia

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

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