Duodenal Mucosa-associated Lymphoid Tissue Lymphoma Research Articles

A Case of Synchronous Primary Gastric and Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma in Remission after Helicobacter pylori Eradication

A Case of Synchronous Primary Gastric and Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma in Remission after <i>Helicobacter pylori</i> Eradication

Primary Duodenal Mucosa-associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy Alone

Primary mucosa-associated with a lymphoid tissue (MALT) lymphoma is a rare distinct subtype of non-Hodgkin's lymphoma that occurs in approximately 8% of all non-Hodgkin lymphomas. Primary gastrointestinal MALT lymphoma usually occurs in the stomach, but duodenal involvement is extremely rare. Therefore, the clinical manifestations, treatment, and prognosis of primary duodenal MALT lymphoma have not yet been validated because of its rarity. This paper reports a case of a 40-year-old male with primary duodenal MALT lymphoma who was treated successfully with radiation therapy alone. A 40-year-old male visited for a medical check-up. Esophagogastroduodenoscopy revealed whitish multi-nodular mucosal lesions in the second and third portions of the duodenum. Biopsy specimens from mucosal lesions in the duodenum were reported to be suspicious for MALT lymphoma of the duodenum. He received a total dose of 3,000 cGy in 15 fractions with external beam radiation therapy for three weeks. Three months after radiation therapy, an endoscopic examination revealed complete resolution of the duodenal lesions. The follow-up 12 months after radiation therapy showed no evidence of tumor recurrence.

A case of gastric and duodenal mucosa-associated lymphoid tissue lymphoma with multiple gastric cancers: a case report

BackgroundGastric mucosa-associated lymphoid tissue (MALT) lymphoma is often caused by Helicobacter pylori and has a good prognosis. Rarely, patients with MALT lymphoma may have gastric cancer and have a poor prognosis.Case presentationWe herein report a case in which surgical treatment was achieved for a 72-year-old male patient with gastric and duodenal MALT lymphoma coexisting multiple gastric cancers. He underwent upper endoscopy for epigastric discomfort, which revealed mucosal erosion on the posterior wall of the middle body of the stomach, an elevated lesion on the duodenal bulb, and a raised tumor on the antrum of the stomach. He was diagnosed with gastric and duodenal MALT lymphoma with early gastric cancer. One month after H. pylori eradication, a second upper endoscopy revealed no improvement in the gastric or duodenal mucosa, and areas of strong redness with a shallow recess just below the cardia of the stomach. As a result, a diagnosis of gastric and duodenal MALT lymphoma with two gastric cancers was made. Total gastrectomy with proximal duodenum resection using intraoperative upper endoscopy and regional lymph node dissection was performed. Pathologically, gastric and duodenal MALT lymphoma and three gastric cancers were detected. Since one of them was an advanced cancer, he started taking S-1 after his general condition improved.ConclusionFor early detection of gastric and duodenal MALT lymphoma or gastric cancer, appropriate upper endoscopy and a biopsy are important. It is necessary to select a suitable treatment, such as H. pylori eradication, endoscopic treatment, surgery, chemotherapy, and irradiation, according to the disease state.

Duodenal Mucosa-associated Lymphoid Tissue Lymphoma Treated with Chemotherapy

Mucosa-associated lymphoid tissue (MALT) lymphomas most commonly occur in the stomach and rarely in the duodenum. Gastric MALT lymphoma is usually associated with &lt;i&gt;Helicobacter pylori&lt;/i&gt; (&lt;i&gt;H. pylori&lt;/i&gt;) infection that may be cured by eradication. However, duodenal MALT lymphoma is not associated with &lt;i&gt;H. pylori&lt;/i&gt; infection. Moreover, the pathophysiology and treatment methods for duodenal MALT lymphoma have not yet been established because the disease is rare. Here, we report a case of duodenal MALT lymphoma. A 58-year-old man was treated for a refractory duodenal ulcer. Based on repeated biopsy, a diagnosis of MALT lymphoma was made. The patient achieved complete remission after chemotherapy and was followed up without recurrence for three years.

Eradication of Helicobacter pylori Infection.

Helicobacter pylori infects about 50% of the world's population, causing at a minimum chronic gastritis. A subset of infected patients will ultimately develop gastric or duodenal ulcer disease, gastric adenocarcinoma, or MALT (mucosa-associated lymphoid tissue) lymphoma. Eradication of H. pylori requires complex regimens that include acid suppression and multiple antibiotics. The efficacy of treatment using what were once considered standard regimens have declined in recent years, mainly due to widespread development of antibiotic resistance. Addition of bismuth to standard triple therapy regimens, use of alternate antibiotics, or development of alternative regimens using known therapies in novel combinations have improved treatment efficacy in specific populations, but overall success of eradication remains less than ideal. Novel regimens under investigation either in vivo or in vitro, involving increased acid suppression ideally with fewer antibiotics or development of non-antibiotic treatment targets, show promise for future therapy.

A Case of Simultaneous Primary Gastric and Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma after Therapeutic Endoscopy

원발성 위 MALT 림프종은 흔하지만 원발성 십이지장 MALT 림프종은 드물며, 위와 십이지장을 동시에 침범한 MALT 림 프종은 매우 드물다. 위와 십이지장의 MALT 림프종의 보고 는 국내와 국외의 증례를 합하여 총 5예에 불과하다. 지금까 지 보고된 증례가 많지 않아 위와 십이지장 MALT 림프종을 동시에 효과적으로 치료할 수 있는 명확한 치료 방침이 없 지만, 저등급 MALT 림프종의 경우에는 첫 치료로 H. pylori 제균을 시도해 볼 수 있고, 추가적으로 항암화학요법 및 방 사선 치료를 고려해 볼 수 있겠다.

Primary gastrointestinal lymphomas - A study of 81 Cases from a Tertiary Healthcare Centre.

Purpose: Retrospective analysis of 81 routinely diagnosed gastrointestinal (GI) lymphoma to illustrate clinicopathological and immunohistochemical characteristics with predisposing condition. Materials and Methods: Age, sex, site, tumour stage, associated pathological features like lympho-epithelial lesion (LEL), atrophic gastritis (AG), intestinal metaplasia (IM) and enteropathy changes were analysed. Requisite immunohistochemical panel was applied wherever needed. Results: There were 55 male and 26 female patients with median age of 54.5 years. Site wise distributions were stomach 40, small intestine 22, colon 4, cecum 2, ileocecum 3, esophagus 1 and multiple sites 9. Histological subtypes were mucosa associated lymphoid tissue lymphoma (MALTOMA) 48, diffuse large B cell lymphoma (DLBL) 21, T cell lymphoma 9 [5 anaplastic large cell lymphoma (ALCL) and 4 enteropathy associated T cell lymphoma (EATL)], immunoproliferative small intestinal disease (IPSID) 2 and follicular lymphoma 1. LEL was present in 31 cases. Of the 19 AG, 8 had associated IM, and 1 case each had associated H Pylori infection and neuroendocrine tumor. Enteropathy was observed in 4 EATL, and one case each of DLBL and high grade MALTOMA. Giardia infection was present in 1 low grade duodenal MALTOMA. Of the 24 resected specimens, 16 were stage IE, 7 stage IIE and 1 stage IV (Mushoff's staging). Conclusion: Primary GI lymphoma was frequently observed in 6 th decade of life with male preponderance. Stomach was the commonest site and high grade MALTOMA being the commonest histological variant. Isolated colonic involvement and intestinal perforations were not infrequent. Rare variants like ALCL and follicular lymphomas were also observed.

Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography

Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.

F-18 FDG PET/CT evaluation of radiotherapy response in rare case of mucosa-associated lymphoid tissue lymphoma

We experienced two cases of mucosa-associated lymphoid tissue (MALT) lymphoma arising at unusual locations and used F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to evaluate their response to radiation therapy (RT). A 62-year-old male with proven prostatic MALT lymphoma and a 43-year-old woman with proven duodenal MALT lymphoma had diffuse FDG uptake in the lesion. Both cases were treated with RT; following FDG, PET/CT showed decreased FDG uptake in each lesion. Neither patient had evidence of recurrence at more than 18 months after RT. FDG PET/CT is useful for indicating the treatment site in MALT lymphoma and in evaluation of therapeutic response following RT.

Duodenal mucosa-associated lymphoid tissue lymphoma masquerading as an ulcer scar

A 62-year-old man was referred to our clinic because of gastric malignancy found on a periodic medical check-up. He had no specific symptoms or signs. Physical examination and routine laboratory studies were normal. Esophagogastroduodenoscopy revealed early gastric cancer (EGC) in the antrum, and there was an additional reddish ulcer scar with fold convergence in the anterior wall of the duodenal bulb. Unlike typical ulcer scar tissue, its mucosa showed patchy erythema and friability. Blood oozed after light touch by the scope ([Fig. 1]). Thus, a biopsy specimen was also taken from the duodenal bulb. Interestingly, histology showed infiltration of atypical lymphocytes with lymphoepithelial lesions. Endoscopic ultrasound (GF-UM 2000, Olympus, Tokyo, Japan) demonstrated hypoechoic wall thickening of the second sonographic layer and focal interruption of the third layer of the duodenum ([Fig. 2]). There were no abnormalities in bone marrow biopsy, abdomen and chest computed tomography scan. He underwent subtotal gastrectomy 4 weeks later. Histological examination revealed that atypical lymphocytes infiltrated diffusely into the mucosal and submucosal layer of the duodenal bulb ([Fig. 3]).

Primary Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Rituximab

MALT lymphoma is the most common primary lymphoma of the GI tract. Though gastric MALT lymphoma is well described, only 17 cases of primary duodenal MALT lymphoma are reported. The use of rituximab has never been reported. A 64 year old man with hypertension had three years of intermittent GI bleeding. Multiple endoscopies showed duodenitis with ulceration. Biopsies of the stomach and duodenum on five occasions showed peptic duodenitis without H. pylori. Work-up for Zollinger-Ellison syndrome was negative and all NSAIDs were discontinued without improvement. Despite a highly selective vagotomy, the duodenitis and ulcerations persisted, prompting referral. On presentation, the patient was taking esomeprazole twice daily and ranitidine nightly. Four weeks after an empiric course of H. pylori therapy, endoscopy showed duodenal erosions with biopsies revealing duodenitis. Sucralfate was started and endoscopy three months later showed duodenitis with an eosinophilic infiltrate. Cromolyn was prescribed and endoscopy four months later was unchanged. However, biopsies revealed a dense CD20-positive lymphocyte infiltrate. MALT lymphoma was confirmed by flow cytometry. PET scan showed increased radiotracer uptake in the duodenum with no metastases. The patient did not want extensive chemotherapy, radiation therapy, or surgery; therefore, a one month course of rituximab was given. A follow-up PET scan showed persistent, though notably less, uptake in the duodenum. An endoscopy revealed persistent MALT lymphoma. In the setting of only a partial response to rituximab, the patient underwent radiation therapy. Of the reported cases of primary duodenal MALT lymphoma, only three patients responded solely to H. pylori eradication. All other cases were treated with either chemotherapy or surgery. Different chemotherapeutic regimens include oral cyclophosphamide; CHOP followed by vinblastine/etoposide/epirubicin/prednisone; CVP; and clarithromycin monotherapy. In the remainder of cases, surgery was the preferred. We avoided more toxic regimens for rituximab, a chimeric monoclonal antibody to CD20-positive lymphocytes. Rituximab has demonstrated efficacy in a variety of lymphomas and with response rates as high as 64% in gastric MALT lymphoma. There are no reports of its use in primary duodenal MALT lymphoma. Given rituximab's ease of administration and reasonable side effect profile, it may be a viable alternative for treatment in the absence of response to H. pylori eradication.

Duodenal Mucosa–Associated Lymphoid Tissue Lymphoma Successfully Treated by Radiation Therapy

Duodenal mucosa–associated lymphoid tissue (MALT) lymphoma is very rare, and little is known about its clinical characteristics, endoscopic and endosonographic features, and treatment. We hereby report a case of duodenal MALT lymphoma successfully treated by radiation therapy (RT). The patient was referred to us with epigastric pain and positive fecal occult blood testing. His symptoms failed to resolve with eradication therapy for a Helicobacter pylori infection that was diagnosed by a gastric biopsy performed elsewhere. Endoscopy at our institution revealed hypertophy of the duodenal folds with erosions involving a third of the circumference few centimeters beyond the ampulla of Vater. Histopathologic and immunophenotypic features were consistent with a MALT lymphoma. There was no evidence of a H. pylori infection by gastric biopsy and urea breath test. Computed tomography scan of the abdomen and pelvis was normal. Endoscopic ultrasound showed thickening of the duodenal wall and hypoechoic infiltration into the submucosal layer. The patient was treated with RT with a complete response. Two and a half years later, he remains in complete clinical, endoscopic, and histopathologic remission. This case illustrates the importance of RT in patients with duodenal MALT lymphoma whose disease did not respond to H. pylori eradication.

Primary Duodenal Mucosa-Associated Lymphoid Tissue (Malt) Lymphoma – a Rare Presentation of Gastric Outlet Obstruction

Malignant lymphoma of mucosa-associated lymphoid tissue (MALT) can arise in a variety of anatomical sites. The majority of these tumors arise in the stomach, with fewer than 30% arising in the small intestine. Primary duodenal MALT lymphoma is a very rare neoplasm. There are very few cases of duodenal MALT lymphoma reported in the literature. This is the third published case presenting clinically as a gastric outlet obstruction. The patient was successfully treated with a combination of chemotherapy and rituximab.

Duodenal MALT Lymphoma Presenting With Obstructive Jaundice: Report of a Case and Review of the Literature

Mucosa-associated lymphoid tissue (MALT) lymphoma is a rare type of non-Hodgkin's lymphoma. The most common site for MALT lymphoma is the stomach. We are reporting a case of a 57-year-old man who presented with obstructive jaundice and was found to have duodenal MALT lymphoma. Unlike gastric MALT lymphoma which is responsive to Helicobacter pylori eradication therapy, duodenal MALT lymphoma does not have a definitive treatment. To our knowledge, this is the first report of a duodenal MALT lymphoma presenting clinically as obstructive jaundice. We describe this case to alert physicians to consider this disease in the differential diagnosis of obstructive jaundice.

Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report

Primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is very rare, and little is known about its clinical course or effective treatment. We describe a case of primary duodenal MALT lymphoma that was resistant to Helicobacter pylori (H. pylori) eradication and regressed after chemotherapy with cyclophosphamide, vincristine, and prednisolone (CVP). A 71-year-old woman was referred to our department because of epigastric pain and dyspepsia. Gastroduodenoscopy revealed an irregular mucosal nodular lesion with ulceration extending from the bulb to the second portion of the duodenum. Histopathological examination of a biopsy specimen disclosed low-grade MALT lymphoma composed of atypical lymphoid cells with lymphoepithelial lesion. Abdominal CT scans revealed 0.5 to 1.5 cm lymph nodes in the peritoneal cavity, suggestive of lymph node metastasis. We successfully eradicated H. pylori but did not see signs of remission. We administered systemic CVP chemotherapy every 3 weeks. After 6 courses of CVP, the patient achieved complete remission and was followed up without recurrence for about a year.

Regression of primary low-grade mucosa-associated lymphoid tissue lymphoma of duodenum after long-term treatment with clarithromycin

A 74-year-old woman was referred to our department because of epigastralgia. Endoscopic findings revealed yellowish bumpy mucosa from the bulbus to the second portion of the duodenum. The patient was admitted to our hospital for further examinations and treatment for this lesion. Endoscopic mucosal resection (EMR) was performed on part of the lesion to obtain the final diagnosis, and then mucosa-associated lymphoid tissue (MALT) lymphoma of the duodenum was diagnosed using this procedure. In this case, no evidence of Helicobacter pylori infection in the patient's stomach was detected by any of the diagnostic examinations used, such as the urea breath test, histological study, culture, and serological antibody. For this reason, the patient's duodenal MALT lymphoma was treated solely with long-term clarithromycin, which had an inhibitory action on lymphocyte activation. The lesion showed slight improved during the first 12 days of treatment, and complete regression was reached after 6 months of treatment. It is suggested that the long-term use of clarithromycin may be effective for diseases of the gastrointestinal tract associated with the lymphocyte proliferation.

Primary Duodenal Low-Grade Mucosa-Associated Lymphoid Tissue Lymphoma Presenting with Outlet Obstruction

Low-grade lymphoma arising in mucosa-associated lymphoid tissue (MALT) of the duodenum represents a very rare neoplasm. We report an unusual presentation of primary duodenal MALT lymphoma in a 78-year-old man. The patient initially presented with a suspected pulmonary embolus and was anticoagulated, which precipitated a major gastrointestinal hemorrhage. A large atypical ulcer with narrowing of the duodenum beyond the bulb was seen on endoscopy. Biopsies revealed atypical lymphoid cells. Abdominal CT scan revealed a mass in either the duodenum or head of the pancreas. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, which revealed a normal pancreatic duct with a large calculus in the common bile duct, which was extracted after sphincterotomy. Elective surgery was planned for suspected lymphoma of the duodenum. The patient developed severe nausea, vomiting, and fullness after meals. The patient underwent pancreaticoduodectomy for a neoplastic mass causing duodenal obstruction. Pathological examination of the resected specimen revealed a low-grade B-cell lymphoma (MALToma) arising in the duodenum and invading the pancreas. Flow cytometry confirmed the phenotype typical of MALT lymphoma. Celiac, peripancreatic, pelvic, and cervical nodes were also involved with tumor. Bone marrow was also positive for metastasis. The patient was postoperatively treated with chemotherapy for stage IV disease.

Duodenal mucosa-associated lymphoid tissue lymphoma treated by eradication of Helicobacter pylori: Report of 2 cases including EUS findings

Although the GI tract is the most common site of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT),1,2 duodenal MALT lymphoma is rare.3-10 The eradication of Helicobacter pylori is now considered the treatment of choice for gastric MALT lymphoma,11-14 yet therapeutic strategies for duodenal MALT lymphoma are still in dispute.3-10 This is a report of 2 cases of duodenal MALT lymphoma, both treated by H pylori eradication. The use of EUS to predict efficacy of eradication is discussed. Informed consent was obtained from each patient for EUS and H pylori eradication therapy.

Regression of primary lymphoma of the ampulla of Vater after eradication of Helicobacter pylori

Primary lymphoma of the major duodenal papilla is extremely rare. 1 Ventrucci M Gherlinzoni F Sabattini E Cipolla A Ubalducci GM Pileri S Primary MALT-lymphoma of the papilla of Vater. Dig Dis Sci. 1998; 43: 214-216 Crossref PubMed Scopus (17) Google Scholar , 2 Pawade J Lee CS Ellis DW Vellar ID Rode J Primary lymphoma of the ampulla of Vater. Cancer. 1994; 73: 2083-2086 Crossref PubMed Scopus (32) Google Scholar , 3 Zhu L Slee GR Domenico DR Mao C Howard JM B-cell lymphoma of ampulla of Vater: observation for six years. Pancreas. 1995; 10: 208-210 Crossref PubMed Scopus (9) Google Scholar , 4 Misdraji J Fernandez del Castillo C Ferry JA Follicle center lymphoma of the ampulla of Vater presenting with jaundice: report of a case. Am J Surg Pathol. 1997; 21: 484-488 Crossref PubMed Scopus (61) Google Scholar , 5 Barek L Orron D Non-Hodgkin's lymphoma presenting as periampullary mass with obstructive jaundice. J Comput Tomogr. 1986; 10: 89-92 Abstract Full Text PDF PubMed Scopus (18) Google Scholar , 6 Kelly SB Price P Williamson RC Non-Hodgkin's lymphoma presenting with jaundice and hypercalcaemia. Clin Oncol (R Coil Radiol). 1993; 5: 122-123 Abstract Full Text PDF PubMed Scopus (7) Google Scholar , 7 Schoeppner HL Wong DK Bresalier RS Primary small bowel lymphoma manifested as obstructive jaundice in a patient with AIDS. South Med J. 1995; 88: 583-585 Crossref PubMed Scopus (10) Google Scholar , 8 Swartz TR Ritchie WG Bile duct obstruction secondary to lymphomatous involvement of the pancreas. J Clin Ultrasound. 1983; 11: 391-394 Crossref PubMed Scopus (14) Google Scholar , 9 Young IF Roberts-Thomson IC Sullivan JR Histiocytic lymphoma presenting with extrahepatic biliary obstruction: a report of three cases. Aust N Z J Surg. 1981; 51: 181-183 Crossref PubMed Scopus (28) Google Scholar , 10 Yoshino T Miyake K Ichimura K Mannami T Ohara N Hamazaki S et al. Increased incidence of follicular lymphoma in the duodenum. Am J Surg Pathol. 2000; 24: 688-693 Crossref PubMed Scopus (196) Google Scholar Patients with lymphoma involving this structure have been treated by pancreatoduodenectomy, radiotherapy, or chemotherapy. Lymphoma of the mucosa-associated lymphoid tissue (MALT), now classified as extranodal marginal zone B-cell lymphoma of MALT type in the World Health Organization (WHO) classification of hematologic malignancies, 11 Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Olin Oncol. 1999; 17: 3835-3849 PubMed Google Scholar are most frequently located in the GI tract. More than 90% of gastric MALT lymphomas are diagnosed in patients with chronic Helicobacter pylori-associated gastritis. High remission rates for these lymphomas have been observed after eradication of H pylori infection. 12 Wotherspoon AC Doglioni C Diss TC Pan L Moschini A de Boni M et al. Regression of primary low-grade B-cell gastric lymphoma of mucosa associated lymphoid tissue type after eradication of Helicobacter pylori. Lancet. 1993; 342: 575-577 Abstract PubMed Scopus (1994) Google Scholar , 13 Nakamura T Nakamura S Yonezumi M Suzuki T Matsuura A Yatabe Y et al. Helicobacter pylori and the t(11;18)(q21;q21) translocation in gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue type. Jpn J Cancer Res. 2000; 91: 301-309 Crossref PubMed Scopus (69) Google Scholar However, little is known about lymphoma arising in the duodenum because it is so rare. The relationships between H pylori infection, duodenal lymphoma, and the possible therapeutic efficacy of H pylori eradication are controversial. 1 Ventrucci M Gherlinzoni F Sabattini E Cipolla A Ubalducci GM Pileri S Primary MALT-lymphoma of the papilla of Vater. Dig Dis Sci. 1998; 43: 214-216 Crossref PubMed Scopus (17) Google Scholar , 14 Nagashima R Takeda H Maeda K Ohno S Takahashi T Regression of duodenal mucosa-associated lymphoid tissue lymphoma after eradication of Helicobacter pylori. Gastroenterology. 1996; 111: 1674-1678 Abstract Full Text PDF PubMed Scopus (94) Google Scholar , 15 Kim JS Jung HC Shin KH Song IS Kim CW Kim CY Eradication of Helicobacter pylori infection did not lead to cure of duodenal mucosa-associated lymphoid tissue lymphoma. Scand J Gastroenterol. 1999; 34: 215-218 PubMed Google Scholar

Helicobacter pylori adhesins: review and perspectives.

It is highly unlikely that chronic infection with H. pylori could occur in the absence of adhesin-host cell interactions. Also, there is no evidence that any of the serious outcomes of H. pylori infection such as gastric and duodenal ulcers, gastric cancer or mucosa-associated lymphoid tissue (MALT) lymphoma could occur without prior colonization of the gastric epithelium mediated by H. pylori adhesins. H. pylori is highly adaptable, as evidenced by the fact that it can occupy a single host for decades. An important facet of this adaptability is its ability to physically interact with various types of host cells and also with host mucins and extracellular matrix proteins using a number of different adhesins displaying a variety of unique receptor specificities. Thus it is highly unlikely that any one particular H. pylori adhesin will ever be proven responsible for a particular outcome such as duodenal ulcer, MALT lymphoma, or adenocarcinoma. Also, while the search for additional H. pylori adhesins should and certainly will continue, we suggest that the scope of this effort should be expanded to include investigations into the patterns of expression and interaction between individual outer membrane proteins. Which of the numerous H. pylori outer membrane proteins (OMPs) actually function as adhesins (i.e., have receptor-binding sites) and which OMPs are simply necessary for optimal display of the adhesive OMPs? There are many other important questions about H. pylori adhesins waiting to be answered. For example, which adhesins are responsible for loose adherence to host cells and which adhesins are responsible for intimate, or membrane-to-membrane, adherence, and do these adhesins normally work in concert or in a sequential fashion? Also, is a specific type of adhesin necessary for type IV protein translocation into host cells and, if so, is adhesin expression coregulated with the effector protein export?