Oesophageal adenocarcinoma or gastric cancer with or without eradication of Helicobacter pylori infection in chronic atrophic gastritis patients: a hypothetical opinion from a systematic review.
BACKGROUND
As chronic atrophic gastritis is a precancerous condition for gastric cancer and the eradication of Helicobacter pylori infection halts chronic gastritis, eradication of infection may prevent gastric cancer. However, as chronic atrophic gastritis is a risk factor for reflux oesophagitis after eradication of infection, the risk of oesophageal adenocarcinoma may also increase.


METHODS
We systematically reviewed papers and estimated the expected annual incidence of oesophageal or gastric cancer with and without eradication of H. pylori infection in patients with chronic atrophic gastritis.


RESULTS
The expected annual incidence of gastric cancer in patients with corpus atrophy with persistent infection was at least 5.8-fold higher than that for oesophageal adenocarcinoma after the eradication of infection at all ages. Even for patients with accompanying reflux oesophagitis or Barrett's oesophagus, the expected incidence of either gastric or oesophageal adenocarcinoma with persistent infection was higher than that of oesophageal adenocarcinoma after eradication of infection.


CONCLUSIONS
If eradication of infection lowers the incidence of gastric cancer, it should be recommended for patients with corpus atrophy at all ages irrespective of the presence of reflux oesophagitis or Barrett's oesophagus, especially in populations having a high prevalence of gastric cancer.
Department of Medicine/Gastroenterology Section, Social Insurance Shiga Hospital, Shiga, Japan. shigeminakajima@msn.com
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Nakajima
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Hattori
D000230:Adenocarcinoma / Q000382:microbiology*; D001471:Barrett Esophagus / Q000382:microbiology*; D004938:Esophageal Neoplasms / Q000382:microbiology*; D004941:Esophagitis / Q000382:microbiology; D005757:Gastritis, Atrophic / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D011230:Precancerous Conditions / Q000382:microbiology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000382:microbiology*