Early detection of gastric cancer after Helicobacter pylori eradication due to endoscopic surveillance

Sakitani, Kosuke; Nishizawa, Toshihiro; Arita, Masahide; Yoshida, Shuntaro; Kataoka, Yasufumi; Ohki, Daisuke; Yamashita, Hiroharu; Isomura, Yoshihiro; Toyoshima, Akira; Watanabe, Hidenobu; Iizuka, Toshiro; Saito, Yutaka; Fujisaki, Junko; Yahagi, Naohisa; Koike, Kazuhiko; Toyoshima, Osamu

doi:10.1111/hel.12503

Cited by 35 publications

(33 citation statements)

References 33 publications

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“…Helicobacter pylori (H. pylori) infection is one of the most prevalent infectious diseases worldwide, with 40 % to 50 % of the global human population estimated to be infected [1]. H. pylori is associated with development of atrophic gastritis and gastric cancer [2][3][4][5], and eradication of H. pylori infection has been reported as an effective strategy for treating atrophic gastritis and peptic ulcer and preventing gastric cancer [6][7][8][9]. There-fore, it is important to estimate H. pylori infection status [10].…”

Section: Introductionmentioning

confidence: 99%

Nodularity-like appearance in the cardia: novel endoscopic findings for Helicobacter pylori infection

Toyoshima

Nishizawa

Sakitani³

et al. 2020

Endosc Int Open

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Background and study aims Helicobacter pylori-associated nodular gastritis, which is associated with follicular lymphoid hyperplasia, is mainly recognized in the antrum. However, we have also observed nodularity-like appearance in the cardia. This study aimed to investigate the clinical signiﬁcance of cardiac nodularity-like appearance in H. pylori-associated gastritis. Patients and methods Patients who underwent esophagogastroduodenoscopy and were evaluated for H. pylori infection for the ﬁrst time were enrolled. A nodularity-like appearance in the cardia was defined as a miliary nodular appearance or scattered appearances of small circular whitish coloration. H. pylori infection was diagnosed according to serum anti-H. pylori antibody and the urea breath test or histology. Accuracy of the H. pylori infection diagnoses based on nodularity-like appearance were assessed. Results Among 265 patients, 42 patients (15.8 %) were diagnosed as positive for H. pylori. Cardiac nodularity-like appearance and antral nodularity were recognized in 25 and 15 patients, respectively. In accuracy of predicting H. pylori by cardiac nodularity-like appearance, specificity was 0.996, sensitivity was 0.571, positive predictive value was 0.960, negative predictive value was 0.925, and accuracy was 0.928. The sensitivity of cardiac nodularity-like appearance was significantly higher than that of antral nodularity (P = 0.0284). Conclusions Cardiac nodularity-like appearance had a high accuracy rate for H. pylori infection diagnosis. Cardiac nodularity-like appearance was found more frequently than antral nodularity.

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Section: Introductionmentioning

confidence: 99%

Nodularity-like appearance in the cardia: novel endoscopic findings for Helicobacter pylori infection

Toyoshima

Nishizawa

Sakitani³

et al. 2020

Endosc Int Open

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“…According to the present study, the gastritis-like appearance is witnessed even immediately after eradication. We therefore call the attention of endoscopists to the screening of H. pylori -eradicated gastric cancer because the early discovery of gastric cancer after eradication may contribute to a better prognosis for the patients [27]. …”

Section: Discussionmentioning

confidence: 99%

Eradication of Helicobacter pylori Induces Immediate Regressive Changes in Early Gastric Adenocarcinomas

et al. 2019

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Objective: Helicobacter pylori eradication is expected to prevent gastric cancer. However, morphological alterations after eradication often hinder accurate diagnosis. Therefore, we evaluated endoscopic and histological changes in gastric tumors after eradication of H. pylori in a time-dependent manner. Methods: We classified 144 cases of endoscopic submucosal dissection (ESD) of early gastric cancer into the following categories: (i) patients positive for H. pylori with no eradication history, (ii) patients positive for H. pylori who underwent ESD 2 months after eradication, (iii) patients negative for H. pylori with an eradication history of at least 6 months before ESD, and (iv) patients negative for H. pylori with an unknown history. We compared endoscopic and histological factors between the groups. Results: The characteristics of cancers positive for H. pylori were exploding shape, superficial high-grade atypical epithelium, and a surface proliferating zone. H. pylori eradication induced a series of endoscopic and histological changes, including shape depression, appearance of surface regenerative and lower-grade atypical epithelium, and a downward shift of the proliferative zone within a period as short as 2 months. Conclusion: H. pylori eradication rapidly causes cancer regression and leads to tumor shrinkage, diminished atypism, and shortened proliferative zone, resulting in drastic morphological changes.

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“…Endoscopic surveillance of patients even after eradication of H. pylori is associated with the detection of early stage cancer and therefore better outcome [126]. A recent review by Rugge et al [164] delivers a comprehensive overview on this topic.…”

Section: Secondary Preventionmentioning

confidence: 99%

The Rationale and Efficacy of Primary and Secondary Prevention in Adenocarcinomas of the Upper Gastrointestinal Tract

Bornschein

Bird‐Lieberman

Malfertheiner

2019

Dig Dis

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While the primary risk factor for oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett’s oesophagus (BO) is gastro-oesophageal reflux, the infection with Helicobacter pylori (H. pylori) is the dominant risk factor for gastric cancer. Reduction of reflux by dietary measures and proton pump inhibitors has some merits in OAC prevention, and the chemopreventive effect of Aspirin and statins is being widely investigated; however, improved outcome in OAC occurs primarily as the result of secondary prevention. Early detection of neoplastic lesions in Barrett’s metaplasia can be achieved by surveillance endoscopies. Novel endoscopic imaging modalities carry similar importance as the endoscopic treatment techniques as without detection of early lesions, therapy cannot be applied. Minimally invasive approaches are currently being investigated to identify patients with BO who are at particular risk of neoplastic progression. While dietary factors also play an important role in the prevention of gastric cancer and chemoprevention seems to be promising, the most beneficial effect has been shown for the eradication of H. pylori infection, which results in at least a one third reduction of gastric cancer risk. This effect can be further improved if the eradication takes place prior to the development of pre-neoplastic gastric conditions such as mucosal atrophy or intestinal metaplasia (IM). The definition of the “point of no return”, after which eradication is less effective, is of high importance, although H. pylori eradication can still be beneficial even at more advance stages of mucosal changes. For this reason, patients with advanced atrophy and IM should undergo endoscopic surveillance in the same way as patients with BO. There is also need for development of non-invasive tests to identify patients at high risk of progression to gastric cancer to improve outcome of these surveillance approaches.

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Early detection of gastric cancer after Helicobacter pylori eradication due to endoscopic surveillance

Cited by 35 publications

References 33 publications

Nodularity-like appearance in the cardia: novel endoscopic findings for Helicobacter pylori infection

Nodularity-like appearance in the cardia: novel endoscopic findings for Helicobacter pylori infection

Eradication of <b><i>Helicobacter pylori</i></b> Induces Immediate Regressive Changes in Early Gastric Adenocarcinomas

The Rationale and Efficacy of Primary and Secondary Prevention in Adenocarcinomas of the Upper Gastrointestinal Tract

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