Clinical application of 20 MHz endosonography and anti-Helicobacter pylori immunoblots to predict regression of low-grade gastric MALToma by H. pylori eradication.
OBJECTIVE
We tested whether serial 20 MHz endosonography (EUS) and anti-Helicobacter pylori immunoblots can predict the complete regression of gastric MALToma by H. pylori eradication.


METHODS
The serums of 17 MALToma patients, including 15 with low grade and two with high grade, were collected before therapy. Fifteen patients with low-grade MALToma and 18 nonMALToma patients, all infected with H. pylori, have been followed with serum sampling, endoscopy, and EUS on enrollment, on the 2nd, 6th, and 12th months after anti-H. pylori therapy. All sera were tested for anti-H. pylori immunoblots, including 19.5, 26.5, 30, 35, 89, 116 KDa (CagA), FldA. The DNAs were extracted serially from the biopsy of MALToma patients before and after therapy to perform polymerase chain reaction (PCR) for the immunoglobulin heavy-chain gene monoclonality.


RESULTS
MALToma patients had higher prevalence rates of anti-FldA protein, 19.5 and 30 KDa antibodies of H. pylori (p < 0.01). After H. pylori eradication, MALToma patients had negative seroconversion of 19.5, 26.5, 30, and 35 KDa antibodies (p < 0.05), but not in CagA and FldA. The PCR monoclonality occurred in 80% (12/15) of the MALToma patients before therapy, but did not correlate with any seroconversion of anti-H. pylori immunoblots after therapy (p > 0.05). Complete regression of MALToma was observed in 73.3% (11/15) of patients. Evaluation with 20 MHz EUS, for the initial tumor depth and its normalization on the 6th month had 90.9% sensitivity and 100% specificity to predict the complete regression.


CONCLUSIONS
The negative seroconversions of the smaller-molecular-weight proteins, but not CagA and FldA, correlate with regression of MALToma by H. pylori eradication. 20 MHz EUS can effectively predict the therapeutic response of MALToma.
Sheu
Bor-Shyang
BS
Department of Internal Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
Shiesh
Shu-Chu
SC
Wang
Jin-Town
JT
Yang
Hsiao-Bai
HB
Lin
Shih-Ting
ST
Wu
Jiunn-Jong
JJ
D000328:Adult; D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial / Q000097:blood; D016022:Case-Control Studies; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D019160:Endosonography; D005260:Female; D005803:Genes, Immunoglobulin; D016481:Helicobacter Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D015151:Immunoblotting; D018442:Lymphoma, B-Cell, Marginal Zone / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial