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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2017

Open Access 01-05-2017

Endoscopic gastric atrophy is strongly associated with gastric cancer development after Helicobacter pylori eradication

Authors: Osamu Toyoshima, Yutaka Yamaji, Shuntaro Yoshida, Shuhei Matsumoto, Hiroharu Yamashita, Takamitsu Kanazawa, Keisuke Hata

Published in: Surgical Endoscopy | Issue 5/2017

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Abstract

Background

Risk factors for gastric cancer during continuous infection with Helicobacter pylori have been well documented; however, little has been reported on the risk factors for primary gastric cancer after H. pylori eradication. We conducted a retrospective, endoscopy-based, long-term, large-cohort study to clarify the risk factors for gastric cancer following H. pylori eradication.

Methods

Patients who achieved successful H. pylori eradication and periodically underwent esophagogastroduodenoscopy surveillance thereafter at Toyoshima Endoscopy Clinic were enrolled. The primary endpoint was the development of gastric cancer. Statistical analysis was performed using the Kaplan–Meier method and Cox’s proportional hazards models.

Results

Gastric cancer developed in 15 of 1232 patients. The cumulative incidence rates were 1.0 % at 2 years, 2.6 % at 5 years, and 6.8 % at 10 years. Histology showed that all gastric cancers (17 lesions) in the 15 patients were of the intestinal type, within the mucosal layer, and <20 mm in diameter. Based on univariate analysis, older age and higher endoscopic grade of gastric atrophy were significantly associated with gastric cancer development after eradication of H. pylori, and gastric ulcers were marginally associated. Multivariate analysis identified higher grade of gastric atrophy (hazard ratio 1.77; 95 % confidence interval 1.12–2.78; P = 0.01) as the only independently associated parameter.

Conclusions

Endoscopic gastric atrophy is a major risk factor for gastric cancer development after H. pylori eradication. Further long-term studies are required to determine whether H. pylori eradication leads to regression of H. pylori-related gastritis and reduces the risk of gastric cancer.
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Metadata
Title
Endoscopic gastric atrophy is strongly associated with gastric cancer development after Helicobacter pylori eradication
Authors
Osamu Toyoshima
Yutaka Yamaji
Shuntaro Yoshida
Shuhei Matsumoto
Hiroharu Yamashita
Takamitsu Kanazawa
Keisuke Hata
Publication date
01-05-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5211-4

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