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Cited by 59Helicobacter pylori-related gastroenterology studiesGastric Cancer Management and OutcomesGastrointestinal Bleeding Diagnosis and Treatment

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

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Toyoshima, Osamu, Yamaji, Yutaka, Yoshida, Shuntaro, Matsumoto, Shuhei, Yamashita, Hiroharu, Kanazawa, Takamitsu, Hata, Keisuke·2017·Surgical Endoscopy
DOI 10.1007/s00464-016-5211-4PMC PMC5411409
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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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Fig. 1 A A case of closed-type atrophy, Grade 3 (C-III): closed atrophy with the atrophic border recognized as an almost symmetrical enclosure and including the antrum and lesser curvature of the proximal gastric body. B The endoscopic-atrophic-border is indicated by a dotted line
Fig. 1 A A case of closed-type atrophy, Grade 3 (C-III): closed atrophy with the atrophic border recognized as an almost symmetrical enclosure and including the antrum and lesser curvature of the proximal gastric body. B The endoscopic-atrophic-border is indicated by a dotted lineCC BY · PubMed Central
Fig. 2 A A case of mild open-type atrophy, Grade 5 (O-II): open atrophy with the atrophic border lying amid the anterior wall. B The endoscopic-atrophic-border is indicated by a dotted line
Fig. 2 A A case of mild open-type atrophy, Grade 5 (O-II): open atrophy with the atrophic border lying amid the anterior wall. B The endoscopic-atrophic-border is indicated by a dotted lineCC BY · PubMed Central
Fig. 3 A A case of severe open-type atrophy, Grade 6 (O-III): open atrophy widely spread with the border between the anterior wall and the greater curvature. B The obscure endoscopic-atrophic-border is indicated by a dotted line
Fig. 3 A A case of severe open-type atrophy, Grade 6 (O-III): open atrophy widely spread with the border between the anterior wall and the greater curvature. B The obscure endoscopic-atrophic-border is indicated by a dotted lineCC BY · PubMed Central
Fig. 4 Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer
Fig. 4 Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancerCC BY · PubMed Central
Fig. 5 Endoscopic images of a typical case of gastric cancer. A White-light imaging. B White-light imaging with indigo carmine dye application
Fig. 5 Endoscopic images of a typical case of gastric cancer. A White-light imaging. B White-light imaging with indigo carmine dye applicationCC BY · PubMed Central
Fig. 6 Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer stratified by the grade of gastric mucosal atrophy
Fig. 6 Kaplan–Meier analysis of the proportion of patients who remained free of gastric cancer stratified by the grade of gastric mucosal atrophyCC BY · PubMed Central

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Research works printed but not linked: 34

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Metadata

Authors
Toyoshima, O., Yamaji, Y., Yoshida, S., Matsumoto, S., Yamashita, H., Kanazawa, T., & Hata, K.
Affiliations
The University of Tokyo (JP)
Corresponding author
Toyoshima, Osamu
ORCID
Venue
Surgical Endoscopy
Publisher
Springer Science and Business Media LLC
Published
2016-09-07
Volume
31
Issue
5
Pages
2140-2148
ISSN
  • 0930-2794 (ISSN-L)
  • 1432-2218
DOI
10.1007/s00464-016-5211-4
PMC
PMC5411409
OpenAlex
W2518082296
Cited by
59
References
0
Citations by year
2026: 3 · 2025: 4 · 2024: 3 · 2023: 7 · 2022: 9 · 2021: 7 · 2020: 14 · 2019: 6 · 2018: 6
FWCI
4.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Surgical Endoscopy (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Japan Society for the Promotion of Science (15H04806)
Topics
  • Health Sciences › Medicine › Gastroenterology › Helicobacter pylori-related gastroenterology studies
  • Health Sciences › Medicine › Oncology › Gastric Cancer Management and Outcomes
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
Keywords
gastric cancer, Helicobacter pylori eradication, atrophic gastritis, risk factors, intestinal-type gastric cancer, gastric ulcer
MeSH terms
Atrophy, Female, Follow-Up Studies, Humans, Japan, Male, Middle Aged, Retrospective Studies, Risk Factors, Stomach, Stomach Neoplasms, Endoscopy, Digestive System, Helicobacter pylori, Helicobacter Infections

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Toyoshima, O., Yamaji, Y., Yoshida, S., Matsumoto, S., Yamashita, H., Kanazawa, T., & Hata, K. (2017). Endoscopic gastric atrophy is strongly associated with gastric cancer development after Helicobacter pylori eradication. Surgical Endoscopy. https://doi.org/10.1007/s00464-016-5211-4