| Theme | Carcinogenesis Based on H. pylori-associated Gastritis -- Is Cancer Control Possible by the Eradication ? | |
|---|---|---|
| Title | Usefulness of Prophylactic Helicobacter pylori Eradication in Gastric Remnants in Preventing Metachronous Gastric Carcinoma | |
| Publish Date | 2012/03 | |
| Author | Takafumi Ando | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Masatoshi Sakakibara | Department of Gastroenterology, Aichi Cancer Center Aichi Hospital |
| Author | Kazuhiro Ishiguro | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Osamu Maeda | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Osamu Watanabe | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| Author | Hidemi Goto | Department of Gastroenterology, Nagoya University Graduate School of Medicine |
| [ Summary ] | Objective : Secondary stomach cancer in remnant stomach lesions occurs relatively soon after distal gastrectomy using the Billroth I reconstruction procedure. Prophylactic eradication of Helicobacter pylori (H. pylori) after endoscopic resection of early gastric cancer should be used to prevent the development of metachronous gastric carcinoma. However, the effects of H. pylori eradication on the gastric remnant has not been clearly determined. We investigated the association of H. pylori infection with histological changes in the gastric remnant. Methods : Nine patients who were H. pylori-positive after distal gastrectomy (eight for gastric cancer, one for gastric ulcer) underwent H. pylori eradication therapy and were followed by endoscopy for 9 years. Upper gastroenteroscopy series were done before and at 1, 3, 5, 7 and 9 years after eradication. Biopsy specimens were taken from the lesser and greater curvatures, respectively. Histological changes, including chronic inflammation, activity, atrophy, and intestinal metaplasia, were evaluated using the updated Sydney system. Results : Successful eradication was confirmed using the urea breath test in all nine patients. Chronic inflammation scores improved after eradication at both the lesser (mean scores: before eradication, 2.9; 1y after, 2.3; 3y, 1.8; 5y, 1.5; 7y, 1.3; and 9y, 1.0) and greater curvatures (before, 2.9; 1y after, 1.9; 3y, 1.4; 5y, 1.3; 7y, 1.1; and 9y, 0.6). Atrophy scores improved more quickly after eradication than chronic inflammation scores at both the lesser (before, 2.4; 1y after, 1.8; 3y, 0.8; 5y, 0.3; 7y, 0.0; and 9y, 0.0) and greater curvatures (before, 2.2; 1y after, 1.3; 3y, 0.5; 5y, 0.0; 7y, 0.0; and 9y, 0.0). No secondary stomach cancers were found with endoscopy. Conclusion: H. pylori eradication improved pre-cancerous lesions in gastric remnants in patients who had undergone distal gastrectomies. Prophylactic H. pylori eradication in the gastric remnants may be useful in preventing the development of metachronous gastric carcinoma. |
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