Predictive factors for metachronous gastric cancer in high-risk patients after successful Helicobacter pylori eradication.
BACKGROUND
Helicobacter pylori eradication following endoscopic mucosal resection of early gastric cancer reduces the risk of metachronous gastric cancer.


OBJECTIVE
To identify subgroups of differing cancer risk after endoscopic mucosal resection of early gastric cancer.


METHODS
Histological assessment of antral and corpus tissue was done by the updated Sydney Classification and serum pepsinogen I and II levels were measured using ELISA kits. Infected patients were treated with a 7-day regimen consisting of amoxicillin, clarithromycin and a proton pump inhibitor.


RESULTS
100 patients were enrolled; in 80 patients H. pylori was successfully eradicated and they were followed up for more than 2 years (median observation period 33 months). Metachronous gastric cancers developed in 9 patients after successful eradication. All cases were men. The frequency of severe atrophy assessed by histology (100 vs. 53.2%, p = 0.03) was higher and pepsinogen I/II ratio before eradication was significantly lower in the group that developed cancer compared to the group that did not. Pepsinogen I <25 ng/ml was significantly associated with development of a new lesion.


CONCLUSIONS
The cancer risk after eradication correlated with the severity of corpus atrophy. It should be possible to identify subgroups requiring intensive and less intensive surveillance after eradication.
Shiotani
Akiko
A
Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan. shiotani@med.kawasaki-m.ac.jp
Uedo
Noriya
N
Iishi
Hiroyasu
H
Yoshiyuki
Yamanaka
Y
Ishii
Manabu
M
Manabe
Noriaki
N
Kamada
Tomoari
T
Kusunoki
Hiroaki
H
Hata
Jiro
J
Haruma
Ken
K
D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology*; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D011237:Predictive Value of Tests; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000209:etiology / Q000473:pathology*
D020115:Pepsinogen C; D020116:Pepsinogen A