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Eradication of H. pylori infection reduces risk for metachronous gastric cancer

Helicobacter pylori infection and serum level of pepsinogen are associated with the risk of metachronous gastric neoplasm after endoscopic resection, reports the latest issue of the Alimentary Pharmacology & Therapeutics.

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Patients who have undergone endoscopic resection of early gastric cancers are at risk for metachronous gastric neoplasm.

Dr Jeon and colleagues from Korea determined whether serum level of pepsinogen, a marker of gastric atrophy, can determine which patients who have undergone endoscopic submucosal dissection for early gastric cancers are at risk for metachronous gastric neoplasm.

The team also investigated the effects of Helicobacter pylori eradication on metachronous gastric neoplasm incidence.

The research team performed a retrospective study of 590 consecutive patients who underwent endoscopic submucosal dissection for early gastric cancers, from 2008 to 2013 at a tertiary centre in South Korea.

Serum levels of pepsinogen were measured at the time of endoscopic submucosal dissection and Helicobacter pylori infection status were recorded.

In case of proven presence of current Helicobacter pylori infection, eradication treatment was provided.

64 patients developed metachronous gastric neoplasms
Alimentary Pharmacology & Therapeutics

Patients underwent follow-up endoscopies at 3 months, 9 months, and each year after the procedure to detect neoplasms and were tested for Helicobacter pylori infection.

The team measured serum levels of pepsinogen at these time points from 442 of the patients.

The main and sub-cohorts were assessed for baseline characteristics, Helicobacter pylori infection, serum level of pepsinogen, and metachronous gastric neoplasm lesions.

During a median follow-up period of 48 months, 64 patients developed metachronous gastric neoplasms.

The research team observed that in the main cohort, risk factors for metachronous gastric neoplasm included persistent Helicobacter pylori infection, and serum ratio of pepsinogen I:pepsinogen II of 3 or less at the time of endoscopic submucosal dissection.

The team found that among patients with serum pepsinogen measurements, persistent Helicobacter pylori infection, and persistent decrease in mean serum ratio of pepsinogen I:pepsinogen II to 3 or less were associated with increased risk of metachronous gastric neoplasm.

Dr Jeon's team comments, "In a retrospective analysis of patients who underwent endoscopic resection of early gastric cancers, eradication of Helicobacter pylori infection reduced risk for metachronous gastric neoplasm."

"Serum ratio of pepsinogen I:pepsinogen II of 3 or less also increase risk of metachronous gastric neoplasm after endoscopic submucosal dissection."

Aliment Pharmacol Ther 2017: 46(8): 758–767
26 September 2017

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