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Open Access Helicobacter pylori eradication may influence timing of endoscopic surveillance for gastric cancer in patients with gastric precancerous lesions

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Abstract

Chronic atrophic gastritis and intestinal metaplasia related to Helicobacter pylori infection, are major risk factors for gastric adenocarcinoma. Eradication of H pylori and endoscopy surveillance of precancerous lesions may reduce the risk and/or lead to early detection of gastric cancer improving survival. In this study, the progression of precancerous lesions after H pylori treatment was evaluated.

Patients with incomplete or complete intestinal metaplasia and/or gastric atrophy at the index endoscopy, were examined for the extension/histological worsening of precancerous lesions at the endoscopy surveillance for gastric cancer. Progression of lesions was evaluated according to H pylori status, age, and sex. Cox proportional hazard regression model and Kaplan–Meier curves were used to evaluate the strength of predictors for lesions progression.

Among 105 patients (61 women) H pylori negative patients showed a milder worsening of gastric lesions between index and surveillance endoscopy compared with patients positive for the infection (log-rank test: P < .0001, P = .012, and P = .032 for antrum, angulus, and corpus, respectively). The Cox regression model showed persistence of H pylori infection (hazard ratio = 4.436; P < .0001) as the only relevant factor for lesion progression, whereas age >65 years and sex were not significant predictors.

According to literature our results demonstrate that H pylori eradication is the major factor able to delay gastric precancerous lesions progression. Time interval for endoscopic surveillance in patients negative for H pylori infection and with gastric precancerous lesions may be extended.
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Keywords: H pylori infection; endoscopic surveillance; gastric atrophy; gastric intestinal metaplasia

Document Type: Research Article

Affiliations: 1: Dipartimento di Medicina Clinica e Sperimentale, Baylor College of Medicine, Houston, Texas. 2: Dipartimento di Medicina Clinica e Sperimentale 3: Dipartimento di Scienze Chirurgiche e Microchirurgiche, University of Sassari, Sassari 4: Dipartimento di Medicina Clinica e Sperimentale, University of Perugia, Perugia, Italy

Publication date: January 1, 2018

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