Usefulness of H elicobacter pylori eradication for precancerous lesions of the gastric remnant

Abstract Background and Aim Secondary stomach cancer in lesions of the remnant stomach occurs relatively soon after distal gastrectomy using the B illroth I reconstruction procedure. Prophylactic eradication of H elicobacter pylori after endoscopic resection of early gastric cancer should be used to...

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Published in:Journal of gastroenterology and hepatology 2014-12, Vol.29 (S4), p.60-64
Main Authors: Sakakibara, Masatoshi, Ando, Takafumi, Ishiguro, Kazuhiro, Maeda, Osamu, Watanabe, Osamu, Hirayama, Yutaka, Morise, Kazuhiro, Maeda, Keiko, Matsushita, Masanobu, Furukawa, Kazuhiro, Funasaka, Kohei, Nakamura, Masanao, Miyahara, Ryoji, Goto, Hidemi
Format: Article
Language:English
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Summary:Abstract Background and Aim Secondary stomach cancer in lesions of the remnant stomach occurs relatively soon after distal gastrectomy using the B illroth I reconstruction procedure. Prophylactic eradication of H elicobacter pylori after endoscopic resection of early gastric cancer should be used to prevent the development of metachronous gastric carcinoma. However, the effect of H . pylori eradication on the gastric remnant has not been clearly determined. Methods Eight patients who were H . pylori ‐positive after distal gastrectomy for primary gastric cancer underwent 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, and 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 S ydney system. Results Successful eradication was confirmed using the urea breath test in all eight patients. Chronic inflammation scores were improved after eradication at both the lesser (mean scores ±  SD : before eradication, 2.9 ± 0.5; 1 year after, 2.3 ± 0.4; 3 years, 1.8 ± 0.3; 5 years, 1.5 ± 0.3; 7 years, 1.3 ± 0.3; and 9 years, 1.0 ± 0.3) and greater curvatures (before, 2.9 ± 0.4; 1 year after, 1.9 ± 0.3; 3 years, 1.4 ± 0.4; 5 years, 1.3 ± 0.3; 7 years, 1.1 ± 0.2; and 9 years, 0.6 ± 0.3). Atrophy scores improved more quickly after eradication than chronic inflammation scores at both the lesser (before, 2.4 ± 0.5; 1 year after, 1.8 ± 0.4; 3 years, 0.8 ± 0.3; 5 years, 0.3 ± 0.1; 7 years, 0.0; and 9 years, 0.0) and greater curvatures (before, 2.2 ± 0.4; 1 year after, 1.3 ± 0.3; 3 years, 0.5 ± 0.3; 5 years, 0.0; 7 years, 0.0; and 9 years, 0.0). No secondary stomach cancers were found on endoscopy. Conclusions Undergoing H . pylori eradication improved possible precancerous lesions of the gastric remnant among patients who had undergone distal gastrectomy. Prophylactic H . pylori eradication in the gastric remnant may be useful in preventing the development of metachronous gastric carcinoma.
ISSN:0815-9319
1440-1746
DOI:10.1111/jgh.12772