Helicobacter pylori eradication therapy for the remnant stomach after gastrectomy.
BACKGROUND
The remnant stomach after surgery for gastric cancer is at high risk for the metachronous development of multiple gastric cancers. Here, we report on eradication therapy of Helicobacter pylori in the remnant stomach, comparing the eradication rate with that in unoperated stomachs. We examined gross and histological changes after treatment.


METHODS
Forty H. pylori-positive patients after distal gastrectomy were treated with proton pump inhibitor (PPI)-based dual and triple therapies. After eradication, histological changes were classified on the basis of the updated Sydney system.


RESULTS
The eradication rate in the remnant stomach was 70% (14 of 20) after dual therapy and 90% (18 of 20) after triple therapy, using per-protocol analysis, and these rates were comparable to the rates of 70% (186 of 264) and 88% (58 of 66), respectively, in nonsurgery patients. After eradication, three sites in the remnant stomach showed similar histological changes: significant decreases in inflammation and activity scores (P < 0.001) and no significant changes in glandular atrophy and intestinal metaplasia scores.


CONCLUSIONS
PPI-based therapy was as effective for H. pylori eradication in the remnant stomach as in the unoperated stomach, and eradication therapy resulted in a significant decrease in inflammatory cell infiltration of the mucosal layer.
Matsukura
Norio
N
Surgery for Organ Function and Biological Regulation (First Department of Surgery), Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Tajiri
Takashi
T
Kato
Shunji
S
Togashi
Akiyoshi
A
Masuda
Gotaro
G
Fujita
Itsuo
I
Tokunaga
Akira
A
Yamada
Nobutaka
N
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D045784:Abietanes / Q000008:administration & dosage; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery*; D005755:Gastrins / Q000097:blood; D016481:Helicobacter Infections / Q000097:blood / Q000382:microbiology* / Q000628:therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D015994:Incidence; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives*; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D045784:Abietanes; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015415:Biomarkers; D005755:Gastrins; D054328:Proton Pump Inhibitors; D017494:Proton Pumps; D064747:Lansoprazole; C061681:ecabet; D020115:Pepsinogen C; D000658:Amoxicillin; D020116:Pepsinogen A; D009853:Omeprazole