Usefulness of Endoscopic Findings for Predicting the Risk of Gastric Cancer after Eradication of Helicobacter pylori

Abstract

Introduction:Helicobacter pylori (HP) is one of important risk factors for gastric cancer. Even after eradication of HP, however, gastric cancer develops in some cases. Endoscopic examination is useful for not only evaluating the severity of gastritis but also screening gastric cancer. Therefore, it is very important to evaluate whether or not endoscopic findings could predict the risk of gastric cancer after eradicating HP. Methods: 42 patients, in whom HP was eradicated from July 2007 to October 2013 and esophago-gastroduodenal endoscopy was performed before and 1, 2 and 3 years after eradicating HP, were enrolled retrospectively. The difference of endoscopic findings was evaluated between the two groups; the cancer group in which gastric cancer developed after eradicating HP, and the non-cancer group. Results: Of 42 patients, 26 were male, and the median age was 65 years (range 35-82 years). Before eradicating HP, the number of patients based on Kimura and Takemoto classification of atrophic gastritis was as follows; C-1 n=4/C-2 n=2/C-3 n=2 /O-1 n=11/ O-2 n=16/O-3 n=7. After eradication of HP, gastric cancers developed in ten patients (23.8 %). Comparing the difference of clinical characteristics between the cancer group and the non-cancer one, the number of patients with severe atrophic gastritis, such as O-2 and O-3, before eradicating HP was significantly greater in the cancer group than that in the noncancer group (p-value<0.05). Even after eradicating HP, moreover, the rate of severe atrophic gastritis in the cancer group was significantly higher than that in the non-cancer group (p-value<0.05).Three years after eradicating HP, particularly, the frequencies of RAC and intestinal metaplasia in the cancer group were less and higher than those in the non-cancer group, respectively (p-value<0.05). Conclusion: Commonly, eradicating HP improves not only the endoscopic findings of atrophic gastritis but also the risk for gastric cancer. However, our data demonstrated the risk for gastric cancer remained still high in patients with severe atrophic gastritis despite eradicating HP.SymbolTherefore, severe atrophic endoscopic-findings after eradicating HP would be useful for predicting the risk of gastric cancer. In conclusion, for the patients with severe atrophic gastritis even after successful eradication of HP, our gastroenterologists should pay attention for the possibility of gastric cancer.Symbol