title: Usefulness of Helicobacter pylori eradication for precancerous lesions of the gastric remnant.
abstract: OBJECTIVE
  Secondary stomach cancer in lesions of the remnant stomach occurs relatively soon after distal gastrectomy using the Billroth I reconstruction procedure. Prophylactic eradication of Helicobacter pylori after endoscopic resection of early gastric cancer should be used to prevent the development of metachronous gastric carcinoma. However, the effect of H. pylori eradication on the gastric remnant has not been clearly determined.
  
  
  METHODS
  Eight patients who were H. pylori-positive after distal gastrectomy for primary gastric cancer underwent eradication therapy and were followed by endoscopy for 9 years. Upper gastroenteroscopy series were done before and at 1, 3, 5, 7 and 9 years after eradication, and biopsy specimens were taken from the lesser and greater curvatures, respectively. Histological changes, including chronic inflammation, activity, atrophy, and intestinal metaplasia, were evaluated using the updated Sydney system.
  
  
  RESULTS
  Successful eradication was confirmed using the urea breath test in all eight patients. Chronic inflammation scores were improved after eradication at both the lesser (mean scores ± SD: before eradication, 2.9±0.5; 1 year after, 2.3±0.4; 3 years, 1.8±0.3; 5 years, 1.5±0.3; 7 years, 1.3±0.3; and 9 years, 1.0±0.3) and greater curvatures (before, 2.9±0.4; 1 year after, 1.9±0.3; 3 years, 1.4±0.4; 5 years, 1.3±0.3; 7 years, 1.1±0.2; and 9 years, 0.6±0.3). Atrophy scores improved more quickly after eradication than chronic inflammation scores at both the lesser (before, 2.4±0.5; 1 year after, 1.8±0.4; 3 years, 0.8±0.3; 5 years, 0.3±0.1; 7 years, 0.0; and 9 years, 0.0) and greater curvatures (before, 2.2±0.4; 1 year after, 1.3±0.3; 3 years, 0.5±0.3; 5 years, 0.0; 7 years, 0.0; and 9 years, 0.0). No secondary stomach cancers were found on endoscopy.
  
  
  CONCLUSIONS
  Undergoing H. pylori eradication improved possible precancerous lesions of the gastric remnant among patients who had undergone distal gastrectomy. Prophylactic H. pylori eradication in the gastric remnant may be useful in preventing the development of metachronous gastric carcinoma.
authors.affiliation: Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Gastroenterology, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Sakakibara
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ando
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ishiguro
authors.forename: Osamu
authors.initials: O
authors.lastname: Maeda
authors.forename: Osamu
authors.initials: O
authors.lastname: Watanabe
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Morise
authors.forename: Keiko
authors.initials: K
authors.lastname: Maeda
authors.forename: Masanobu
authors.initials: M
authors.lastname: Matsushita
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Furukawa
authors.forename: Kohei
authors.initials: K
authors.lastname: Funasaka
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.forename: Ryoji
authors.initials: R
authors.lastname: Miyahara
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: D000328:Adult; D000368:Aged; D060740:Disease Eradication; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D018530:Gastric Stump; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology*; D005773:Gastroscopy; D016481:Helicobacter Infections; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000517:prevention & control*; D011230:Precancerous Conditions; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D013997:Time Factors
keywords: Helicobacter pylori eradication; gastric remnant; metachronous gastric carcinoma