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. 2017 May;31(5):2140-2148.
doi: 10.1007/s00464-016-5211-4. Epub 2016 Sep 7.

Endoscopic gastric atrophy is strongly associated with gastric cancer development after Helicobacter pylori eradication

Osamu Toyoshima  1 , Yutaka Yamaji  2 , Shuntaro Yoshida  3 , Shuhei Matsumoto  3 , Hiroharu Yamashita  3   4 , Takamitsu Kanazawa  3 , Keisuke Hata  3   5
Affiliations

Endoscopic gastric atrophy is strongly associated with gastric cancer development after Helicobacter pylori eradication

Osamu Toyoshima et al. Surg Endosc. 2017 May.

Abstract

Background: Risk factors for gastric cancer during continuous infection with Helicobacter pylori have been well documented; however, little has been reported on the risk factors for primary gastric cancer after H. pylori eradication. We conducted a retrospective, endoscopy-based, long-term, large-cohort study to clarify the risk factors for gastric cancer following H. pylori eradication.

Methods: Patients who achieved successful H. pylori eradication and periodically underwent esophagogastroduodenoscopy surveillance thereafter at Toyoshima Endoscopy Clinic were enrolled. The primary endpoint was the development of gastric cancer. Statistical analysis was performed using the Kaplan-Meier method and Cox's proportional hazards models.

Results: Gastric cancer developed in 15 of 1232 patients. The cumulative incidence rates were 1.0 % at 2 years, 2.6 % at 5 years, and 6.8 % at 10 years. Histology showed that all gastric cancers (17 lesions) in the 15 patients were of the intestinal type, within the mucosal layer, and <20 mm in diameter. Based on univariate analysis, older age and higher endoscopic grade of gastric atrophy were significantly associated with gastric cancer development after eradication of H. pylori, and gastric ulcers were marginally associated. Multivariate analysis identified higher grade of gastric atrophy (hazard ratio 1.77; 95 % confidence interval 1.12-2.78; P = 0.01) as the only independently associated parameter.

Conclusions: Endoscopic gastric atrophy is a major risk factor for gastric cancer development after H. pylori eradication. Further long-term studies are required to determine whether H. pylori eradication leads to regression of H. pylori-related gastritis and reduces the risk of gastric cancer.

Keywords: Atrophic gastritis; Chemoprevention; Endoscopy; Helicobacter pylori; Risk factors; Stomach neoplasms.

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Conflict of interest statement

Drs. Osamu Toyoshima, Yutaka Yamaji, Shuntaro Yoshida, Shuhei Matsumoto, Hiroharu Yamashita, Takamitsu Kanazawa, and Keisuke Hata have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
A A case of closed-type atrophy, Grade 3 (C-III): closed atrophy with the atrophic border recognized as an almost symmetrical enclosure and including the antrum and lesser curvature of the proximal gastric body. B The endoscopic-atrophic-border is indicated by a dotted line
Fig. 2
Fig. 2
A A case of mild open-type atrophy, Grade 5 (O-II): open atrophy with the atrophic border lying amid the anterior wall. B The endoscopic-atrophic-border is indicated by a dotted line
Fig. 3
Fig. 3
A A case of severe open-type atrophy, Grade 6 (O-III): open atrophy widely spread with the border between the anterior wall and the greater curvature. B The obscure endoscopic-atrophic-border is indicated by a dotted line
Fig. 4
Fig. 4
Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer
Fig. 5
Fig. 5
Endoscopic images of a typical case of gastric cancer. A White-light imaging. B White-light imaging with indigo carmine dye application
Fig. 6
Fig. 6
Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer stratified by the grade of gastric mucosal atrophy
See this image and copyright information in PMC

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