Early Attempts to Eradicate Helicobacter pylori after Endoscopic Resection of Gastric Neoplasm Significantly Improve Eradication Success Rates.

Cheal Wung Huh,Da Hyun Jung,Young Hoon Youn,Hyojin Park,Jae Jun Park,Jie-Hyun Kim,Masaru Katoh

doi:10.1371/journal.pone.0162258

Cheal Wung Huh, Da Hyun Jung + Show 5 more

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https://doi.org/10.1371/journal.pone.0162258

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Journal: PloS one	Publication Date: Sep 2, 2016
Citations: 11	License type: CC BY 4.0

Affiliation: Gangnam Severance Hospital, Yonsei University

Abstract

PurposeAfter endoscopic resection (ER) of gastric tumors, eradication of Helicobacter pylori (H. pylori) infection is advised to reduce metachronous recurrence. Optimal timing of such therapy (yet to be established) was investigated herein, examining early active and late scarring stages of post-ER iatrogenic ulcers.Materials and MethodsAnalysis included 514 patients who received proton-pump inhibitor (PPI)-based triple therapy for H. pylori eradication after ER for gastric neoplasms between January 2008 and June 2015. Clinicopathologic characteristics, particularly the timing of triple therapy, were used to compare eradication rates, assigning patients to early- (≤2 weeks), intermediate- (2–8 weeks), and late-phase (≥8 weeks) treatment groups.ResultsH. pylori eradication rates differed significantly by timing of triple therapy after ER (early, 90.0%; intermediate, 76.2%, late, 72.4%; p <.001). However, eradication success rates were not significantly affected by age, smoking, alcohol consumption, preexisting comorbidity, method of ER, size and location of iatrogenic ulcer, and duration of therapeutic regimen. Early initiation of H. pylori eradication was also identified as a significant independent predictor of eradication success in multivariate analysis (Odds ratio = 3.67, 95% CI 2.18–6.16; p <.001).ConclusionIn patients undergoing ER of gastric tumors, early post-ER attempts at eradication of H. pylori offer the best chance of eradication success.

Highlights

Endoscopic resection (ER) is a widely accepted means of treating gastric adenomas and types of early gastric cancer (EGC), generally through endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR)[1,2]
Initiation of H. pylori eradication was identified as a significant independent predictor of eradication success in multivariate analysis (Odds ratio = 3.67, 95% CI 2.18–6.16; p
In patients undergoing ER of gastric tumors, early post-ER attempts at eradication of H. pylori offer the best chance of eradication success

Summary

Introduction

Endoscopic resection (ER) is a widely accepted means of treating gastric adenomas and types of early gastric cancer (EGC), generally through endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR)[1,2]. As with peptic ulcer disease (PUD), eradication of H. pylori is an important therapeutic indication in this setting, dictated by post-ER status[6,7,9,10,11]. Researchers are actively seeking ways to improve eradication rate of H. pylori, given the gradually declining success rates due primarily to acquired antibiotic resistance[12,13,14]. Factors impacting eradication of H. pylori include smoking habits, alcohol consumption, age, body mass index, underlying disease, CYP2C19 genotype, existing PUD, patient compliance, regimen duration, and antibiotic resistance[15,16,17]. Few studies have addressed factors influencing H. pylori eradication rates in the aftermath of ER, and none have focused on the optimal timing of therapy to eradicate H. pylori post-ER

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