Download PDF
Endosc Int Open 2015; 03(04): E311-E317
DOI: 10.1055/s-0034-1392090
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic atrophic classification before and after H. pylori eradication is closely associated with histological atrophy and intestinal metaplasia

Masaaki Kodama
Institution Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
,
Tadayoshi Okimoto
Institution Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
,
Ryo Ogawa
Institution Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
,
Kazuhiro Mizukami
Institution Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
,
Kazunari Murakami
Institution Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
› Author Affiliations
Further Information

Publication History

submitted 03 March 2015

accepted 16 March 2015

Publication Date:
26 May 2015 (online)

Also available at
   Permissions and Reprints

Background and study aims: The relationship between endoscopic atrophy classification (EAC) and histological gastric atrophy and intestinal metaplasia (IM) was examined before and after Helicobacter pylori (H. pylori) eradication in order to evaluate the usefulness of EAC for detecting the risk of gastric cancer following eradication.

Patients and methods: A total of 230 patients (137 males, 93 females; mean age: 58.0 ± 11.8 y) with successful eradication were enrolled. EAC score was defined as follows: C0(none): 0, C1: 1, C2: 2, C3: 3, O1: 4, O2: 5, and O3(severe): 6. Histological atrophy and IM score (0 to 3) from the antrum and the corpus were evaluated with updated Sydney system for histological atrophy and IM.

Results: The mean EAC scores were 3.46 before eradication and 3.20 after eradication (P = 0.026). The mean atrophy scores before and after eradication were 1.45 and 0.92 at the antrum (P < 0.001) and 0.50 and 0.07 at the corpus (P < 0.001), respectively. The mean IM scores before and after eradication were 0.55 and 0.47 at the antrum (P = 0.154), and 0.09 and 0.05 at the corpus (P = 0.096), respectively. The histological atrophy scores showed significant improvement after eradication, while IM showed no significant change. The Mantel-Haenszel test for trend indicated there was a significant correlation between EAC and histological atrophy and IM, except antral atrophy after eradication.

Conclusions: EAC exhibited a significant correlation between histological atrophy and IM, and represents a noninvasive classification method. EAC may be beneficial in evaluating the risk of gastric cancer after H. pylori eradication.

 

  • References

  • 1 Huang JQ, Sridhar S, Chen Y et al. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology 1998; 114: 1169-1179
    CrossrefPubMedGoogle Scholar
  • 2 Uemura N, Okamoto S, Yamamoto S et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001; 345: 784-778
    CrossrefPubMedGoogle Scholar
  • 3 Fuccio L, Zagari RM, Eusebi LH et al. Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer?. Ann Intern Med 2009; 151: 121-128 ; Erratum in: Ann Intern Med 2009; 151: 516
    CrossrefPubMedGoogle Scholar
  • 4 Ito M, Takata S, Tatsugami M et al. Clinical prevention of gastric cancer by Helicobacter pylori eradication therapy: a systematic review. J Gastroenterol 2009; 44: 365-371
    CrossrefPubMedGoogle Scholar
  • 5 Take S, Mizuno M, Ishiki K et al. The long-term risk of gastric cancer after the successful eradication of Helicobacter pylori. J Gastroenterol 2011; 46: 318-324
    CrossrefPubMedGoogle Scholar
  • 6 Fukase K, Kato M, Kikuchi S et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008; 372: 392-397
    CrossrefPubMedGoogle Scholar
  • 7 Correa P. Human gastric carcinogenesis: a multistep and multifactorial process-first American Cancer Society award lecture on cancer epidemiology and prevention. Cancer Res 1992; 52: 6735-6740
    PubMedGoogle Scholar
  • 8 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969; 3: 87-97
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Satoh K, Kimura K, Taniguchi Y et al. Distribution of inflammation and atrophy in the stomach of Helicobacter pylori-positive and –negative patients with chronic gastritis. Am J Gastroenterol 1996; 91: 963-969
    PubMedGoogle Scholar
  • 10 Take S, Mizuno M, Ishiki K et al. The effect of eradicating Helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol 2005; 100: 1037-1042
    CrossrefPubMedGoogle Scholar
  • 11 Kodama M, Murakami K, Okimoto T et al. Histological characteristics of gastric mucosa prior to Helicobacter pylori eradication may predict gastric cancer. Scand J Gastroenterol 2013; 48: 1249-1256
    PubMedGoogle Scholar
  • 12 Murakami K, Kodama M, Sato R et al. Helicobacter pylori eradication and associated changes in the gastric mucosa. Expert Rev Anti Infect Ther 2005; 3: 757-764
    CrossrefPubMedGoogle Scholar
  • 13 Rokkas T, Pistiolas D, Sechopoulos P et al. The long-term impact of Helicobacter pylori eradication on gastric histology: a systematic review and meta-analysis. Helicobacter 2007; 12: 32-38
    CrossrefPubMedGoogle Scholar
  • 14 Wang J, Xu L, Shi R et al. Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis. Digestion 2011; 83: 253-260
    CrossrefPubMedGoogle Scholar
  • 15 Kodama M, Murakami K, Okimoto T et al. Ten-year prospective follow-up of histological changes at 5 points on the gastric mucosa as recommended by the updated Sydney system after Helicobacter pylori eradication. J Gastroenterol 2012; 47: 394-403
    CrossrefPubMedGoogle Scholar
  • 16 Dixon MF, Genta RM, Yardley JH et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
    PubMedGoogle Scholar
  • 17 Bae SE, Jung HY, Kang J et al. Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm. Am J Gastroenterol 2014; 109: 60-67
    CrossrefPubMedGoogle Scholar
  • 18 Choi J, Kim SG, Yoon H et al. Eradication of Helicobacter pylori after endoscopic resection of gastric tumors does not reduce incidence of metachronous gastric carcinoma. Clin Gastroenterol Hepatol 2014; 12: 793-800
    CrossrefPubMedGoogle Scholar
  • 19 Watari J, Moriichi K, Tanabe H et al. Biomarkers predicting development of metachronous gastric cancer after endoscopic resection: an analysis of molecular pathology of Helicobacter pylori eradication. Int J Cancer 2012; 130: 2349-2358
    CrossrefPubMedGoogle Scholar
  • 20 Kim HJ, Hwang SW, Kim N et al. Helicobacter pylori and Molecular Markers as Prognostic Indicators for Gastric Cancer in Korea. J Cancer Prev 2014; 19: 56-67
    CrossrefPubMedGoogle Scholar
  • 21 Leung WK, Sung JJY. Intestinal metaplasia and gastric carcinogenesis. Aliment Pharmacol Ther 2002; 16: 1209-1216
    CrossrefPubMedGoogle Scholar
  • 22 Kamada T, Hata J, Sugiu K et al. Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan. Aliment Pharmacol Ther 2005; 21: 1121-1126
    CrossrefPubMedGoogle Scholar
  • 23 Tashiro J, Miwa J, Tomita T et al. gastric cancer detected after Helicobacter pylori eradication. Digestive Endoscopy 2007; 19: 167-173
    CrossrefPubMedGoogle Scholar
  • 24 Whiting JL, Sigurdsson A, Rowlands DC et al. The long term results of endoscopic surveillance of premalignant gastric lesions. Gut 2002; 50: 378-381
    CrossrefPubMedGoogle Scholar
  • 25 Nakayoshi T, Tajiri H, Matsuda K et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 2004; 36: 1080-1084
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Uedo N, Ishihara R, Iishi H et al. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy 2006; 38: 819-824
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Okubo M, Tahara T, Shibata T et al. Usefulness of magnifying narrow-band imaging endoscopy in the Helicobacter pylori-related chronic gastritis. Digestion 2011; 83: 161-166
    CrossrefPubMedGoogle Scholar
  • 28 Liu Y, Uemura N, Xiao SD et al. Agreement between endoscopic and histological gastric atrophy scores. J Gastroenterol 2005; 40: 123-127
    CrossrefPubMedGoogle Scholar
  • 29 Kato M, Terao S, Adachi K et al. Study Group for Establishing Endoscopic Diagnosis of Chronic Gastritis. Changes in endoscopic findings of gastritis after cure of H. pylori infection: multicenter prospective trial. Dig Endosc 2013; 25: 264-273
    CrossrefPubMedGoogle Scholar
  • 30 Quach DT, Le HM, Hiyama T et al. Relationship between endoscopic and histologic gastric atrophy and intestinal metaplasia. Helicobacter 2013; 18: 151-157
    CrossrefPubMedGoogle Scholar
  • 31 Shiotani A, Uedo N, Iishi H et al. H. pylori eradication did not improve dysregulation of specific oncogenic miRNAs in intestinal metaplastic glands. J Gastroenterol 2012; 47: 988-998
    CrossrefPubMedGoogle Scholar