title: Predictive factors for metachronous gastric cancer in high-risk patients after successful Helicobacter pylori eradication.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan. shiotani@med.kawasaki-m.ac.jp
authors.forename: Akiko
authors.initials: A
authors.lastname: Shiotani
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Yamanaka
authors.initials: Y
authors.lastname: Yoshiyuki
authors.forename: Manabu
authors.initials: M
authors.lastname: Ishii
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.forename: Tomoari
authors.initials: T
authors.lastname: Kamada
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kusunoki
authors.forename: Jiro
authors.initials: J
authors.lastname: Hata
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
mesh_terms: 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*
chemical_list: D020115:Pepsinogen C; D020116:Pepsinogen A