Usefulness of Helicobacter pylori eradication for precancerous lesions of the gastric remnant

作者：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

来源：Journal of Gastroenterology and Hepatology, 2014, 29: 60-64.

DOI：10.1111/jgh.12772

• gastric remnant
• Helicobacter pylori eradication
• metachronous gastric carcinoma

Background and AimSecondary stomach cancer in lesions of the remnant stomach occurs relatively soon after distal gastrectomy using the Billroth I reconstruction procedure. Prophylactic eradication of Helicobacter 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. %26lt;br%26gt;MethodsEight 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 Sydney system. %26lt;br%26gt;ResultsSuccessful eradication was confirmed using the urea breath test in all eight patients. Chronic inflammation scores were improved after eradication at both the lesser (mean scoresSD: 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. %26lt;br%26gt;ConclusionsUndergoing 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.

• 出版日期2014-12