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Usefulness of H elicobacter pylori eradication for precancerous lesions of the gastric remnant
Author(s) -
Sakakibara Masatoshi,
Ando Takafumi,
Ishiguro Kazuhiro,
Maeda Osamu,
Watanabe Osamu,
Hirayama Yutaka,
Morise Kazuhiro,
Maeda Keiko,
Matsushita Masanobu,
Furukawa Kazuhiro,
Funasaka Kohei,
Nakamura Masanao,
Miyahara Ryoji,
Goto Hidemi
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12772
Subject(s) - medicine , helicobacter pylori , gastric tumor , gastroenterology , stomach
Abstract Background and Aim Secondary stomach cancer in lesions of the remnant stomach occurs relatively soon after distal gastrectomy using the B illroth I reconstruction procedure. Prophylactic eradication of H elicobacter pylori after endoscopic resection of early gastric cancer should be used to prevent the development of metachronous gastric carcinoma. However, the effect of H . pylori eradication on the gastric remnant has not been clearly determined. Methods Eight patients who were H . pylori ‐positive after distal gastrectomy for primary gastric cancer underwent eradication therapy and were followed by endoscopy for 9 years. Upper gastroenteroscopy series were done before and at 1, 3, 5, 7 and 9 years after eradication, and biopsy specimens were taken from the lesser and greater curvatures, respectively. Histological changes, including chronic inflammation, activity, atrophy, and intestinal metaplasia, were evaluated using the updated S ydney system. Results Successful eradication was confirmed using the urea breath test in all eight patients. Chronic inflammation scores were improved after eradication at both the lesser (mean scores ± SD : before eradication, 2.9 ± 0.5; 1 year after, 2.3 ± 0.4; 3 years, 1.8 ± 0.3; 5 years, 1.5 ± 0.3; 7 years, 1.3 ± 0.3; and 9 years, 1.0 ± 0.3) and greater curvatures (before, 2.9 ± 0.4; 1 year after, 1.9 ± 0.3; 3 years, 1.4 ± 0.4; 5 years, 1.3 ± 0.3; 7 years, 1.1 ± 0.2; and 9 years, 0.6 ± 0.3). Atrophy scores improved more quickly after eradication than chronic inflammation scores at both the lesser (before, 2.4 ± 0.5; 1 year after, 1.8 ± 0.4; 3 years, 0.8 ± 0.3; 5 years, 0.3 ± 0.1; 7 years, 0.0; and 9 years, 0.0) and greater curvatures (before, 2.2 ± 0.4; 1 year after, 1.3 ± 0.3; 3 years, 0.5 ± 0.3; 5 years, 0.0; 7 years, 0.0; and 9 years, 0.0). No secondary stomach cancers were found on endoscopy. Conclusions Undergoing H . pylori eradication improved possible precancerous lesions of the gastric remnant among patients who had undergone distal gastrectomy. Prophylactic H . pylori eradication in the gastric remnant may be useful in preventing the development of metachronous gastric carcinoma.