Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 21 April 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Postponing oncological treatment may be justifiable in patients with low-grade gastric MALT lymphoma, after successful eradication of H. pylori

A watch-and-wait approach to the management of localized low-grade gastric MALT-type lymphoma after the eradication of Helicobacter pylori could be a valid strategy claims a research letter in the journal The Lancet.

News image

fiogf49gjkf04

Helicobacter pylori infection is known to play an important part in the development and progression of MALT (mucosa-associated lymphoid tissue)-type gastric lymphoma, and eradication of H. pylori is well established as an initial treatment for MALT lymphoma that is confined to the gastric wall.

In cases where progression of the disease, or of lymphoma infiltrates, continues 12 months after eradication of H. pylori, patients are usually referred for surgery or radiotherapy.

In a research letter to the latest edition of The Lancet, Professor Wolfgang Fischbach and colleagues from the University of Würzburg, in Würzburg, Germany, describe their experiences with 7 patients who declined further treatment.

The research group investigated 5 male and 2 female patients, aged 43 to 69 years, who were diagnosed with low-grade gastric MALT-type lymphoma (extranodal marginal zone B-cell lymphoma, according to the revised European American lymphoma (REAL) and WHO classifications) by review of centralized histological records.

H pylori infection was shown histologically and by the rapid urease test.

Complete diagnostic work-up, which included abdominal and cervical ultrasound, thoracic and abdominal CT, bone marrow puncture, and endoscopic gastric ultrasound, showed stage I lymphoma (according to the Ann Arbor staging system) in all patients.

Patients received triple therapy with omeprazole, clarithromycin, and metronidazole or amoxycillin, and were followed up with endoscopy and gastric biopsy every 3 months.

Endoscopy showed that the initial macroscopic lesions had returned to normal or revealed features of post H pylori gastritis only.

All patients became negative for H. pylori by the rapid urease test, and on repeat biopsies.

However, lymphoma regression was not achieved within 12 months after successful eradication of the bacterium, as shown by histological and immunohistochemical examination.

Potential strategies for gastric MALT lymphoma - could be broader than previously thought
The Lancet

The researchers took biopsy samples by use of a mapping protocol (antrum, 4 biopsies; corpus, 4; fundus, 2; and any visible lesion, 8 to 10).

Clonality and presence of t(11;18) translocations were then determined by standard immunoglobulin-gene-rearrangement-PCR and PCR for API2-MALT1 chimeric transcripts.

The researchers found there to be no signs of lymphoma progression or high-grade transformation within a median observation time of 34 months (range 20-44 months).

A total of 4 out of 5 patients tested were positive for t(11;18) at initial diagnosis.

One of these patients became negative for t(11;18) 20 months after eradication therapy, whereas the other 3 remained positive during follow-up.

Commenting on their findings, the researchers say that they saw no cases of lymphoma progression or high-grade transformation within an observation period of almost 3 years.

They add that the potential strategies for management of patients with gastric MALT lymphoma might, therefore, be broader than previously thought, and could include a watch-and-wait strategy.

Continuing, they say that the finding that more cases were t(11;18) positive than were negative is in accord with those of recent reports on MALT lymphoma after H. pylori eradication, but that since patients who are negative for t(11;18) show many more clonal aberrations than those who are positive, as shown by microsatellite analysis, such patients may need more intensive follow-up.

The research group end by cautioning that they investigated only a few cases and so this strategy should be tested in a larger series of patients with long-term follow-up, including detailed molecular analyses.

Also, patients managed by a watch-and-wait strategy should be compared with those receiving standard oncological treatment.

"We believe that to postpone oncological treatment is justifiable in patients with minimal residual stage I low-grade gastric MALT lymphoma, after successful eradication of H. pylori. Very thorough investigations are, however, mandatory when deciding to do so."

Lancet 2002; 360(9332): 547-548
19 August 2002

Go to top of page Email this page Email this page to a colleague

 20 April 2018 
Obesity and physical activity in diverticulosis
 20 April 2018 
Worldwide H.pylori prevalence
 20 April 2018 
Adalimumab with azathioprine in Crohn's
 20 April 2018 
Antibody suitable for further clinical development to complement existing therapeutic strategies for HCV
 19 April 2018 
Fibrosis in patients with chronic hepatitis B
 19 April 2018 
c-Myc expression and pancreatic cancer
 19 April 2018 
Olmesartan prescription in the USA
 18 April 2018 
Online tool predicts bowel dysfunction severity prior to anterior resection
 18 April 2018 
Hep C treatment for sustained virologic response
 18 April 2018 
Endoscopic necrosectomy reduces risk of death 
 17 April 2018 
Colorectal cancer screening and ethnic inequities
 17 April 2018 
Training programs should consider radiation education for advanced endoscopy fellows
 17 April 2018 
Aspirin and pancreatic cancer
 16 April 2018 
Surgery for colorectal polyps has increased 
 16 April 2018 
Advanced fibrosis can be ruled out in primary health care patients
 16 April 2018 
Antibiotic use and colorectal adenoma
 13 April 2018 
Colorectal cancer cell lines
 13 April 2018 
Infliximab and corticosteroid-free clinical remission in Crohn's
 13 April 2018 
Teduglutide for children with short bowel syndrome
 12 April 2018 
Prescriptions for opiate drugs amongst primary care patients with IBD
 12 April 2018 
Lower GI bleeding related to comorbidity
 12 April 2018 
non–Clostridium difficile bacterial infections in IBD
 11 April 2018 
Physician perception of IBD trial results
 11 April 2018 
Bile acid deficiency in IBS 
 11 April 2018 
Stem cell therapy for fistulas in Crohn's
 10 April 2018 
Overweight in childhood and type 2 diabetes
 10 April 2018 
immunoglobulin G associates with clinical features of IBD
 10 April 2018 
T-cells repertoires in celiac disease
 09 April 2018 
Biomarker tests for colorectal cancer screening
 09 April 2018 
Fecal transplantation in C. difficile infection and treatment outcome 
 09 April 2018 
No weigh-loss drug improved all cardiometabolic risk factors
 06 April 2018 
Colonoscopy and colorectal cancer mortality
 06 April 2018 
Eosinophilic esophagitis and health-related quality of life
 06 April 2018 
Microbiome in athletes vs sedentary subjects
 05 April 2018 
Laparoscopic Nissen fundoplication for GERD treatment
 05 April 2018 
Random biopsies for neoplasia in IBD
 05 April 2018 
Scoring system identifies cancer risk in Barrett's
 04 April 2018 
Alpha‐1 antitrypsin deficiency and liver disease
 04 April 2018 
PPI and risk of stroke
 04 April 2018 
Adjuvant chemotherapy for advanced colon cancer
 29 March 2018 
Prevention of metachronous gastric cancer
 29 March 2018 
Acute lower GI bleeding
 28 March 2018 
Decision aid used by IBD patients
 28 March 2018 
Transition for young adults with IBD
 28 March 2018 
Amitriptyline in functional dyspepsia
 27 March 2018 
Emergency department utilization for IBD 
 27 March 2018 
Management of hemorrhoids in the USA
 27 March 2018 
Adult ulcerative colitis
 26 March 2018 
Biological therapy response in IBD 
 26 March 2018 
Obesity and diverticulosis
 26 March 2018 
Practice guidelines for chronic constipation
 23 March 2018 
Health-related quality of life in eosinophilic esophagitis
 23 March 2018 
Genetics and chronic liver disease
 23 March 2018 
Global prevalence of H.pylori
 22 March 2018 
H. pyloris and gastric cancer
 22 March 2018 
Pancreatitis after IBS treatment 
 22 March 2018 
Mechanisms of action in patients with IBS
 21 March 2018 
Panel markers for early detection of colon cancer

 21 March 2018 
Blood test differentiates celiac disease
 21 March 2018 
Patient characteristics and colonoscopy preparation

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us