title: Is the polymerase chain reaction or cure of Helicobacter pylori infection of help in the differential diagnosis of early gastric mucosa-associated lymphatic tissue lymphoma?
abstract: OBJECTIVE
  The differential diagnosis of early gastric mucosa-associated lymphatic tissue (MALT) lymphoma based on Helicobacter pylori gastritis may be difficult when lymphoepithelial lesions are not detected. The aim of the present study was to investigate the question whether the polymerase chain reaction (PCR) or cure of H pylori infection may be of help in this respect.
  
  
  METHODS
  Twenty patients with suspected low-grade gastric MALT lymphomas were treated in a double-blinded, randomized, crossover trial with 2,250 mg of either amoxicillin or placebo, both in combination with omeprazole, for 14 days with the aim to cure H pylori infection. PCR was performed using primers specific for the CDR3 region to detect monoclonal B cells.
  
  
  RESULTS
  In five of 20 patients, MALT lymphomas were finally diagnosed. Three of these five patients went into complete remission, while two were referred to surgery. In the 15 patients with gastritis, complete regression was observed in all cases. With respect to PCR, monoclonal bands were detected in all four of the analyzed lymphoma patients before histology showed lymphoma. In addition, monoclonal bands were found in three patients with gastritis. In the patients with gastritis and monoclonal PCR, complete regression took longer as compared with the remaining 12 patients with polyclonal PCR and gastritis (P = .0209). Successful H pylori eradication was associated with earlier diagnosis of the MALT lymphoma (P = .0237).
  
  
  CONCLUSIONS
  CDR3-PCR may be of help in the differential diagnosis of early gastric MALT lymphoma. Furthermore, H pylori eradication may lead to earlier diagnosis.
authors.affiliation: Otto-von-Guericke Universität, Abteilung für Gastroenterologie, Magdeburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Rudolph
authors.forename: E
authors.initials: E
authors.lastname: Bayerdörffer
authors.forename: M
authors.initials: M
authors.lastname: Ritter
authors.forename: S
authors.initials: S
authors.lastname: Müller
authors.forename: C
authors.initials: C
authors.lastname: Thiede
authors.forename: B
authors.initials: B
authors.lastname: Neubauer
authors.forename: N
authors.initials: N
authors.lastname: Lehn
authors.forename: E
authors.initials: E
authors.lastname: Seifert
authors.forename: P
authors.initials: P
authors.lastname: Otto
authors.forename: R
authors.initials: R
authors.lastname: Hatz
authors.forename: M
authors.initials: M
authors.lastname: Stolte
authors.forename: A
authors.initials: A
authors.lastname: Neubauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D018592:Cross-Over Studies; D003937:Diagnosis, Differential; D004311:Double-Blind Method; D005260:Female; D005756:Gastritis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D016133:Polymerase Chain Reaction
chemical_list: D000897:Anti-Ulcer Agents; D010406:Penicillins; D000658:Amoxicillin; D009853:Omeprazole