Gastric MALT lymphomas: the value of an endoscopic follow-up evaluation.
BACKGROUND
Findings have demonstrated the close association between primary gastric B-cell lymphomas originating from mucosa-associated lymphoid tissue (MALT) and Helicobacter pylori (HP) infection, with their regression after an HP eradication therapy in up to 70% of the cases. Endoscopic-biopsy diagnosis and endoscopic ultrasound are of major importance as decisive prognostic factors and therapeutic determinants.


OBJECTIVE
We report 3 years of experience and follow-up evaluation in the management of MALT lymphomas. We also describe the guidelines strategy therapy used in our institution.


METHODS
Since July 1996, nine patients with a histologic diagnosis of low-grade, HP-positive MALT gastric lymphomas, have been followed up. All patients had stage IE lymphomas (according to Musshoff classification). Eradication of HP was performed with triple therapy amoxycillin, clarithromycin, and omeprazole using over a 14-day period. The patients were seen for endoscopic follow-up assessment after 3, 6, 9, and 15 months, then twice a year. The actual median follow-up time was 30.4 months (range, 16-38 months).


RESULTS
All the patients are now free of disease and asymptomatic. We have registered two cases of HP relapse (both after 1-year follow-up evaluation), positively treated with the same triple therapy, and three cases of disease relapse treated with single-dose chemotherapy (plus radiotherapy in one patient).


CONCLUSIONS
In our experience the eradication of HP appears to be effective, and we consider it the first therapeutic option in patients with stage IE gastric low-grade MALT lymphoma, although long-term results are still needed. Prolonged follow-up evaluation (particularly by endoscopy) is necessary (and feasible in our experience) to determine whether these remissions are long-lasting. We recommend that HP be eradicated in these lymphomas before referral to other standard treatment.
Agresta
F
F
Endoscopic Unit, Department of General Surgery, Civil Hospital, Vittorio Veneto (TV), Italy.
Trentin
G
G
Mainente
P
P
Della Libera
D
D
Bianco
A
A
Salvagno
L
L
D000368:Aged; D000900:Anti-Bacterial Agents; D001706:Biopsy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011706:Pyloric Antrum; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000175:diagnosis*; D013997:Time Factors
D000900:Anti-Bacterial Agents