Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Songpa-gu, Seoul, Korea.
Helicobacter. 2011 Feb;16(1):36-41. doi: 10.1111/j.1523-5378.2010.00807.x.
Eradication of Helicobacter pylori with antibiotics is the established initial treatment of patients with localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, there are few reports on follow-up modalities to identify sustained remission in patients who achieve complete remission (CR). We therefore investigated the role of abdominal computed tomography (CT) as follow-up after CR with H. pylori eradication.
We retrospectively analyzed 122 patients with H. pylori-positive stage I(E1) gastric MALT lymphoma who achieved CR with successful H. pylori eradication.
The median follow-up after CR was 35 months (range 3-140 months). At a median of 17 months (range 12-21 months) after CR, 7 of 122 patients (5.7%) experienced lymphoma recurrence, all cases of which were confined to the gastric mucosa and were detectable only by endoscopy with multiple biopsies. At the time of recurrence, four of seven patients showed re-infection by H. pylori. Eradication therapy was successful in these patients, resulting in both bacterial eradication and tumor regression. Three patients who experienced histologic recurrence without H. pylori re-infection were observed by a watch and wait strategy and again achieved CR.
None of the patients with H. pylori-positive stage I(E1) gastric MALT lymphoma who experienced tumor recurrence after CR with successful H. pylori eradication showed recurrence at extragastric sites, including lymph nodes without gastric mucosal lesion. These findings indicate that endoscopic biopsies without abdominal CT scans are sufficient to detect recurrence in these patients.
根除幽门螺杆菌（H. pylori）联合抗生素治疗是局部胃黏膜相关淋巴组织（MALT）淋巴瘤患者的初始标准治疗方案。然而，对于实现完全缓解（CR）的患者，目前报道的用于确认持续缓解的随访方式较少。因此，我们研究了在根除 H. pylori 后实现 CR 的患者中，采用腹部计算机断层扫描（CT）作为随访手段的作用。
我们回顾性分析了 122 例 H. pylori 阳性的 I 期（E1）胃 MALT 淋巴瘤患者，这些患者经 H. pylori 根除治疗后达到了 CR。
CR 后中位随访时间为 35 个月（范围 3-140 个月）。在 CR 后中位 17 个月（范围 12-21 个月）时，122 例患者中有 7 例（5.7%）经历了淋巴瘤复发，所有病例均局限于胃黏膜，仅通过内镜下多次活检才能检测到。在复发时，7 例中有 4 例显示 H. pylori 再感染。这些患者的根除治疗取得了成功，既实现了细菌根除，也使肿瘤消退。3 例出现无 H. pylori 再感染的组织学复发患者采用了观察等待策略，再次获得了 CR。
在根除 H. pylori 后成功实现 CR 并经历肿瘤复发的 H. pylori 阳性的 I 期（E1）胃 MALT 淋巴瘤患者中，无一例出现胃黏膜外部位（包括无胃黏膜病变的淋巴结）的复发。这些发现表明，对于这些患者，仅进行内镜活检而不进行腹部 CT 扫描即可检测到复发。
