title: Helicobacter pylori associated gastric intestinal metaplasia: Treatment and surveillance.
abstract: Gastric cancer (GC) is one of the leading causes of cancer related death in the world, particularly in East Asia. According to the Correa's cancer cascade, non-cardia GC is usually developed through a series of mucosal changes from non-atrophic gastritis to atrophic gastritis (AG), intestinal metaplasia (IM), dysplasia and adenocarcinoma. Atrophic gastritis and IM are therefore generally considered to be pre-neoplastic gastric lesions. Helicobacter pylori (H. pylori) infection is an important initiating and promoting step of this gastric carcinogenesis cascade. Emerging long-term data showed that eradication of H. pylori reduced the risk of subsequent cancer development. It however remains confusing whether eradication of the bacterium in individuals with pre-neoplastic gastric lesions could regress these changes as well as in preventing cancer. Whilst H. pylori eradication could likely regress AG, the presence of IM may be a point of no return in this cascade. Hence, surveillance by endoscopy may be indicated in those with extensive IM or those with incomplete IM, particularly in populations with high GC risk. The optimal interval and the best tool of surveillance endoscopy remains to be determined in future studies.
authors.affiliation: Kevin Sze-Hang Liu, Wai K Leung, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
authors.forename: Kevin Sze-Hang
authors.initials: KS
authors.lastname: Liu
authors.affiliation: Kevin Sze-Hang Liu, Wai K Leung, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
authors.forename: Irene Oi-Ling
authors.initials: IO
authors.lastname: Wong
authors.affiliation: Kevin Sze-Hang Liu, Wai K Leung, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
authors.forename: Wai K
authors.initials: WK
authors.lastname: Leung
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D018450:Disease Progression; D005753:Gastric Mucosa / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology; D005756:Gastritis / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D008679:Metaplasia; D011230:Precancerous Conditions / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gastric cancer; Helicobacter pylori; Intestinal metaplasia; Surveillance; Treatment
references.citation: Am J Gastroenterol. 2000 Jun;95(6):1431-8
references.pmid: 10894575
references.citation: Am J Pathol. 2000 Sep;157(3):729-35
references.pmid: 10980112
references.citation: N Engl J Med. 2001 Sep 13;345(11):784-9
references.pmid: 11556297
references.citation: Aliment Pharmacol Ther. 2002 Nov;16(11):1923-32
references.pmid: 12390101
references.citation: Aliment Pharmacol Ther. 2003 Jun 1;17(11):1333-43
references.pmid: 12786627
references.citation: J Natl Cancer Inst Monogr. 2003;(31):102-10
references.pmid: 12807953
references.citation: Cancer Res. 1992 Dec 15;52(24):6735-40
references.pmid: 1458460
references.citation: JAMA. 2004 Jan 14;291(2):187-94
references.pmid: 14722144
references.citation: Gastric Cancer. 2004;7(1):9-16
references.pmid: 15052434
references.citation: Gut. 2004 Sep;53(9):1244-9
references.pmid: 15306578
references.citation: Gut. 2005 Jun;54(6):764-8
references.pmid: 15888780
references.citation: Cancer Epidemiol Biomarkers Prev. 2005 Dec;14(12):2982-6
references.pmid: 16365021
references.citation: Gastrointest Endosc. 2006 Apr;63(4):570-80
references.pmid: 16564854
references.citation: Am J Gastroenterol. 2006 Apr;101(4):714-20
references.pmid: 16635219
references.citation: J Natl Cancer Inst. 2006 Jul 19;98(14):974-83
references.pmid: 16849680
references.citation: Clin Cancer Res. 2006 Aug 1;12(15):4766-72
references.pmid: 16899628
references.citation: Gut. 2007 May;56(5):631-6
references.pmid: 17142647
references.citation: Helicobacter. 2007 Nov;12 Suppl 2:32-8
references.pmid: 17991174
references.citation: Int J Technol Assess Health Care. 2008 Winter;24(1):87-95
references.pmid: 18218173
references.citation: Lancet Oncol. 2008 Mar;9(3):279-87
references.pmid: 18308253
references.citation: Gastroenterology. 2008 May;134(5):1570-95
references.pmid: 18384785
references.citation: Gastroenterology. 2008 Apr;134(4):945-52
references.pmid: 18395075
references.citation: World J Gastroenterol. 2008 May 21;14(19):3021-7
references.pmid: 18494053
references.citation: Helicobacter. 2008 Aug;13(4):245-55
references.pmid: 18665932
references.citation: Int J Cancer. 2009 Jan 1;124(1):157-66
references.pmid: 18823009
references.citation: N Engl J Med. 2009 May 28;360(22):2277-88
references.pmid: 19474425
references.citation: Scand J Gastroenterol. 1991 Oct;26(10):1057-65
references.pmid: 1947772
references.citation: Cancer Causes Control. 2009 Dec;20(10):2021-9
references.pmid: 19642005
references.citation: Am J Gastroenterol. 2010 Mar;105(3):493-8
references.pmid: 20203636
references.citation: Helicobacter. 2010 Feb;15(1):1-20
references.pmid: 20302585
references.citation: Gastrointest Endosc. 2010 Jun;71(7):1150-8
references.pmid: 20381801
references.citation: Gut. 2010 Aug;59(8):1143-53
references.pmid: 20525969
references.citation: Helicobacter. 2010 Jun;15(3):221-6
references.pmid: 20557364
references.citation: Cancer. 2010 Jun 15;116(12):2941-53
references.pmid: 20564399
references.citation: Gastroenterology. 2010 Dec;139(6):1894-1901.e2; quiz e12
references.pmid: 20727889
references.citation: Cancer Causes Control. 2011 Mar;22(3):375-87
references.pmid: 21184266
references.citation: Digestion. 2011;83(4):253-60
references.pmid: 21282951
references.citation: Gut. 2012 Jun;61(6):812-8
references.pmid: 21917649
references.citation: Dig Dis Sci. 2012 Mar;57(3):746-52
references.pmid: 21984437
references.citation: Endoscopy. 2012 Jan;44(1):74-94
references.pmid: 22198778
references.citation: Gut. 2012 May;61(5):646-64
references.pmid: 22491499
references.citation: Cancer Treat Rev. 2013 Feb;39(1):60-7
references.pmid: 23102520
references.citation: Int J Cancer. 2013 Sep 1;133(5):1023-32
references.pmid: 23280711
references.citation: J Dig Dis. 2013 May;14(5):211-21
references.pmid: 23302262
references.citation: Helicobacter. 2013 Oct;18(5):325-37
references.pmid: 23566268
references.citation: Helicobacter. 2013 Oct;18(5):338-46
references.pmid: 23607896
references.citation: World J Gastroenterol. 2013 Jun 21;19(23):3615-22
references.pmid: 23801863
references.citation: Cochrane Database Syst Rev. 2013 Sep 23;(9):CD009322
references.pmid: 24062262
references.citation: Virchows Arch. 2014 Apr;464(4):403-7
references.pmid: 24477629
references.citation: Eur J Gastroenterol Hepatol. 2014 Apr;26(4):378-87
references.pmid: 24569821
references.citation: J Gastroenterol Hepatol. 2014;29(7):1371-86
references.pmid: 24758240
references.citation: BMJ. 2014 May 20;348:g3174
references.pmid: 24846275
references.citation: World J Gastroenterol. 2014 May 21;20(19):5903-11
references.pmid: 24914352
references.citation: J Natl Cancer Inst. 2014 Jun 12;106(7):null
references.pmid: 24925350
references.citation: Clin Gastroenterol Hepatol. 2015 Mar;13(3):480-487.e2
references.pmid: 25117772
references.citation: Helicobacter. 2014 Dec;19(6):425-36
references.pmid: 25164596
references.citation: Int J Cancer. 2015 Mar 1;136(5):E359-86
references.pmid: 25220842
references.citation: Dig Dis. 2015;33(1):5-10
references.pmid: 25531491
references.citation: Gastric Cancer. 2016 Jan;19(1):166-75
references.pmid: 25609452
references.citation: Hong Kong Med J. 2014 Dec;20 Suppl 7:13-5
references.pmid: 25647818
references.citation: Gut. 2015 Aug;64(8):1209-19
references.pmid: 25731870
references.citation: Gut. 2016 Apr;65(4):563-74
references.pmid: 25779597
references.citation: Gut. 2016 Mar;65(3):400-7
references.pmid: 25869737
references.citation: Gastric Cancer. 2016 Apr;19(2):543-52
references.pmid: 25920526
references.citation: Gut. 2015 Sep;64(9):1353-67
references.pmid: 26187502
references.citation: Hepatogastroenterology. 2015 May;62(139):748-51
references.pmid: 26897966
references.citation: J Natl Cancer Inst. 1980 Aug;65(2):231-40
references.pmid: 6931245
references.citation: Histochem J. 1981 Nov;13(6):931-9
references.pmid: 7338482
references.citation: IARC Monogr Eval Carcinog Risks Hum. 1994;61:177-240
references.pmid: 7715070
references.citation: Mod Pathol. 1993 May;6(3):281-9
references.pmid: 8346176
references.citation: Lancet. 1996 Jul 20;348(9021):150-4
references.pmid: 8684154
references.citation: Arch Intern Med. 1999 Jan 25;159(2):142-8
references.pmid: 9927096