Characteristics and predictors of gastric cancer after Helicobacter pylori eradication

Abstract

Helicobacter pylori (H. pylori) eradication can reduce gastric cancer. However, gastric cancer still develops after eradication, and cases who received eradication therapy are increasing. In this study, we have reviewed the characteristics and predictors of primary gastric cancer developing after H. pylori eradication. In terms of the characteristics, endoscopic, histologic, and molecular characteristics are reported. Endoscopically, gastric cancer after eradication is often depressed-type and shows a gastritis-like appearance, which sometimes makes the diagnosis difficult. Histologically, most gastric cancer after eradication is intestinal type, and non-neoplastic epithelium, also called epithelium with low-grade atypia, is frequently seen over the tumor, which is presumably the cause of the endoscopic gastritis-like appearance. As for molecular characteristics, some markers, such as Ki67, MUC2, and Wnt5a expression, are lower in cancer from patients in whom H. pylori has been eradicated. In terms of predictors, several Japanese studies have reported that severe endoscopic atrophy at eradication is a risk factor for gastric cancer development. Histologic intestinal metaplasia, especially in the corpus, and long-term use of proton pump inhibitors, are also reported as risk factors for gastric cancer after H. pylori eradication. These studies on the characteristics and predictors of gastric cancer development will become the cornerstone for establishing a novel surveillance program based on the gastric cancer risk stratification specific to H. pylori-eradicated patients.

Keywords: Characteristic; Eradication; Gastric cancer; Helicobacter pylori; Predictor.

Figure 1

Gastritis-like appearance. A: White light image by conventional endoscopy. Slightly reddish depressed lesion is detected in posterior wall of the upper part of the corpusl; B: A gastritis-like appearance under narrow-band imaging under magnifying endoscopy; C: Well-differentiated tubular adenocarcinoma with low-grade atypia (HE, orig. mag. ×100). Note the non-neoplastic epithelium (arrows) partially covered the surface of the adenocarcinoma (arrowheads).

Figure 2

Intestinal metaplasia in the corpus. A: Endoscopic image of the intestinal metaplasia in the corpus. Greyish-white, slightly opalescent, flat, elevated lesions of various sizes; B: Narrow-band imaging under a magnifying endoscopy image, light blue crest appears as blue-white lines visible on the epithelial surface[75]; C: Microscopic picture of a biopsy specimen with intestinal metaplasia (HE, orig. mag. ×100).