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  • Title: Predictive factors for metachronous gastric cancer in high-risk patients after successful Helicobacter pylori eradication.
    Author: Shiotani A, Uedo N, Iishi H, Yoshiyuki Y, Ishii M, Manabe N, Kamada T, Kusunoki H, Hata J, Haruma K.
    Journal: Digestion; 2008; 78(2-3):113-9. PubMed ID: 19023205.
    Abstract:
    BACKGROUND: Helicobacter pylori eradication following endoscopic mucosal resection of early gastric cancer reduces the risk of metachronous gastric cancer. AIM: To identify subgroups of differing cancer risk after endoscopic mucosal resection of early gastric cancer. METHODS: Histological assessment of antral and corpus tissue was done by the updated Sydney Classification and serum pepsinogen I and II levels were measured using ELISA kits. Infected patients were treated with a 7-day regimen consisting of amoxicillin, clarithromycin and a proton pump inhibitor. RESULTS: 100 patients were enrolled; in 80 patients H. pylori was successfully eradicated and they were followed up for more than 2 years (median observation period 33 months). Metachronous gastric cancers developed in 9 patients after successful eradication. All cases were men. The frequency of severe atrophy assessed by histology (100 vs. 53.2%, p = 0.03) was higher and pepsinogen I/II ratio before eradication was significantly lower in the group that developed cancer compared to the group that did not. Pepsinogen I <25 ng/ml was significantly associated with development of a new lesion. CONCLUSIONS: The cancer risk after eradication correlated with the severity of corpus atrophy. It should be possible to identify subgroups requiring intensive and less intensive surveillance after eradication.
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