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. 2015 Dec;15(4):246-55.
doi: 10.5230/jgc.2015.15.4.246. Epub 2015 Dec 31.

Helicobacter pylori Eradication Reduces the Metachronous Recurrence of Gastric Neoplasms by Attenuating the Precancerous Process

Da Hyun Jung  1 , Jie-Hyun Kim  1 , Yong Chan Lee  2 , Sang Kil Lee  2 , Sung Kwan Shin  2 , Jun Chul Park  2 , Hyun Soo Chung  2 , Hyunki Kim  3 , Hoguen Kim  3 , Yong Hoon Kim  1 , Jae Jun Park  1 , Young Hoon Youn  1 , Hyojin Park  1
Affiliations

Helicobacter pylori Eradication Reduces the Metachronous Recurrence of Gastric Neoplasms by Attenuating the Precancerous Process

Da Hyun Jung et al. J Gastric Cancer. 2015 Dec.

Abstract

Purpose: The importance of Helicobacter pylori eradication after endoscopic resection (ER) of gastric neoplasms remains controversial. In this study, we clarified the importance of H. pylori eradication for metachronous lesions after ER.

Materials and methods: This study included 3,882 patients with gastric neoplasms who underwent ER. We included patients infected with H. pylori who received eradication therapy. Among them, 34 patients with metachronous lesions after ER and 102 age- and sex-matched patients (nonmetachronous group) were enrolled. Background mucosal pathologies such as atrophy and intestinal metaplasia (IM) were evaluated endoscopically. The expression levels of CDX1, CDX2, Sonic hedgehog (SHH), and SOX2 were evaluated based on H. pylori eradication and the development of metachronous lesions.

Results: The eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.036). Open-type atrophy (P=0.003) and moderate-to-severe IM (P=0.001) occurred more frequently in the metachronous group. In patients with an initial diagnosis of dysplasia, the eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.002). In addition, open-type atrophy was more frequent in the metachronous group (P=0.047). In patients with an initial diagnosis of carcinoma, moderate-to-severe IM occurred more frequently in the metachronous group (P=0.003); however, the eradication failure rate was not significantly different between the two groups. SHH and SOX2 expression was increased, and CDX2 expression was decreased in the nonmetachronous group after eradication (P<0.05).

Conclusions: Open-type atrophy, moderate-to-severe IM, and H. pylori eradication failure were significantly associated with metachronous lesions. However, eradication failure was significantly associated with dysplasia, but not carcinoma, in the metachronous group. Thus, H. pylori eradication may play an important role in preventing metachronous lesions after ER for precancerous lesions before carcinomatous transformation.

Keywords: Endoscopic resection; Helicobacter pylori; Metachronous; Stomach neoplasms.

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Conflict of interest statement

Conflicts of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Protein expression of SOX2, sonic hedgehog (SHH), CDX2, and CDX1 in the background gastric mucosa (×400). (A, B) Immunohistochemical staining for SOX2. Nuclear SOX2 expression increases after Helicobacter pylori eradication in the nonmetachronous group (A) in which metachronous gastric neoplasms do not arise (B). (C, D) Immunohistochemical staining for CDX2. The nuclear expression of CDX2 decreases after H. pylori eradication in the nonmetachronous group (D) in which metachronous gastric neoplasms do not arise (C). (E, F) Immunohistochemical staining for SHH. Cytoplasmic SHH expression increases after H. pylori eradication in the nonmetachronous group (E) in which metachronous gastric neoplasms do not arise (F). (G, H) Immunohistochemical staining for CDX1. The nuclear expression of CDX1 is not significantly different after H. pylori eradication between the nonmetachronous and metachronous groups. (G) Positive CDX1 expression; (H) negative CDX1 expression.
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