title: Changing the natural history of metachronous gastric cancer afterH. pylorieradication.
abstract: Metachronous gastric cancer occurs frequently following endoscopic removal of an early gastric cancer.H. pylorieradication significantly reduces that risk. While, the pathogenesis of this phenomenon remains unclear, it is clear that the natural history of metachronous gastric cancer is altered followingH. pylorieradication. Genetic instability of host cells induced by inflammation,H. pylori, host or environmental factors can result in the production of malignant cells.H. pylorieradication reduces and alters the inflammation, and can reverse epigenetic damage and abnormal expression of miRNA's. Fundamentally,H. pylorieradication stops the progression and may reverse some of the damage to the mucosa resulting in improved acid secretion and improving the gastric microbiome. Because the risk of developing metachronous cancer varies among patients, prospective research is needed to identify reliable biomarkers to predict development of metachronous cancer as well as to define surveillance methods, intervals, and duration. Some candidate examples of prognostic or predictive biomarkers for the prediction of subsequent risk include the presence or absence, titers, and changes in anti-H.pyloriIgG and or anti-CagA antibodies, serum pepsinogens, gastrin, and miRNAs.
authors.affiliation: Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, 77030 USA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.affiliation: Cancer Vaccine Center, Kurume University, Kurume, Fukuoka, 839-0863 Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Matsueda
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Shiotani