Dynamics ofHelicobacter pyloriinfection as a determinant of progression of gastric precancerous lesions: 16-year follow-up of an eradication trial
- 7 June 2017
- Vol. 67 (7), 1239-1246
- https://doi.org/10.1136/gutjnl-2016-311685
Abstract
Objective: To evaluate the long-term effect of cumulative time exposed toHelicobacter pyloriinfection on the progression of gastric lesions.Design: 795 adults with precancerous gastric lesions were randomised to receive anti-H. pyloritreatment at baseline. Gastric biopsies were obtained at baseline and at 3, 6, 12 and 16 years. A total of 456 individuals attended the 16-year visit. Cumulative time ofH. pyloriexposure was calculated as the number of years infected during follow-up. Multivariable logistic regression models were used to estimate the risk of progression to a more advanced diagnosis (versus no change/regression) as well as gastric cancer risk by intestinal metaplasia (IM) subtype. For a more detailed analysis of progression, we also used a histopathology score assessing both severity and extension of the gastric lesions (range 1–6). The score difference between baseline and 16 years was modelled by generalised linear models.Results: Individuals who were continuously infected withH. pylorifor 16 years had a higher probability of progression to a more advanced diagnosis than those who cleared the infection and remained negative after baseline (p=0.001). Incomplete-type IM was associated with higher risk of progression to cancer than complete-type (OR, 11.3; 95% CI 1.4 to 91.4). The average histopathology score increased by 0.20 units/year (95% CI 0.12 to 0.28) among individuals continuously infected withH. pylori. The effect of cumulative time of infection on progression in the histopathology score was significantly higher for individuals with atrophy (without IM) than for individuals with IM (pH. pyloriinfection was associated with progression of precancerous lesions. Individuals infected withH. pyloriwith these lesions may benefit from eradication, particularly those with atrophic gastritis without IM. Incomplete-type IM may be a useful marker for the identification of individuals at higher risk for cancer.Keywords
Funding Information
- Office of Medical Research, Department of Veterans Affairs, USA
- National Cancer Institute
- Pasto Cancer Registry, Centro de Estudios en Salud, Universidad de Nariño
- Intramural Research Program, U.S. National Institutes of Health, National Cancer Institute
This publication has 41 references indexed in Scilit:
- The benefit of mass eradication ofHelicobacter pyloriinfection: a community-based study of gastric cancer preventionGut, 2012
- Fifteen-Year Effects of Helicobacter pylori, Garlic, and Vitamin Treatments on Gastric Cancer Incidence and MortalityJNCI Journal of the National Cancer Institute, 2012
- Gastritis OLGA‐staging and gastric cancer risk: a twelve‐year clinico‐pathological follow‐up studyAlimentary Pharmacology & Therapeutics, 2010
- Pathology of Gastric Intestinal Metaplasia: Clinical ImplicationsAmerican Journal of Gastroenterology, 2010
- Helicobacter pylori Eradication Prevents Progression of Gastric Cancer in Hypergastrinemic INS-GAS MiceCancer Research, 2008
- OLGA staging for gastritis: A tutorialDigestive and Liver Disease, 2008
- American College of Gastroenterology Guideline on the Management of Helicobacter pylori InfectionAmerican Journal of Gastroenterology, 2007
- Gastritis staging in clinical practice: the OLGA staging systemGut, 2007
- Randomized Double-Blind Factorial Trial of Three Treatments To Reduce the Prevalence of Precancerous Gastric LesionsJNCI Journal of the National Cancer Institute, 2006
- Long term follow up of patients treated for Helicobacter pylori infectionGut, 2005