Watari Jiro, Chen Nancy, Amenta Peter S, Fukui Hirokazu, Oshima Tadayuki, Tomita Toshihiko, Miwa Hiroto, Lim Kheng-Jim, Das Kiron M
Jiro Watari, Hirokazu Fukui, Tadayuki Oshima, Toshihiko Tomita, Hiroto Miwa, Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya 663-8501, Japan.
World J Gastroenterol. 2014 May 14;20(18):5461-73. doi: 10.3748/wjg.v20.i18.5461.
Helicobacter pylori (H. pylori) infection is well known to be associated with the development of precancerous lesions such as chronic atrophic gastritis (AG), or gastric intestinal metaplasia (GIM), and cancer. Various molecular alterations are identified not only in gastric cancer (GC) but also in precancerous lesions. H. pylori treatment seems to improve AG and GIM, but still remains controversial. In contrast, many studies, including meta-analysis, show that H. pylori eradication reduces GC. Molecular markers detected by genetic and epigenetic alterations related to carcinogenesis reverse following H. pylori eradication. This indicates that these changes may be an important factor in the identification of high risk patients for cancer development. Patients who underwent endoscopic treatment of GC are at high risk for development of metachronous GC. A randomized controlled trial from Japan concluded that prophylactic eradication of H. pylori after endoscopic resection should be used to prevent the development of metachronous GC, but recent retrospective studies did not show the tendency. Patients with precancerous lesions (molecular alterations) that do not reverse after H. pylori treatment, represent the "point of no return" and may be at high risk for the development of GC. Therefore, earlier H. pylori eradication should be considered for preventing GC development prior to the appearance of precancerous lesions.
众所周知，幽门螺杆菌（H. pylori）感染与癌前病变如慢性萎缩性胃炎（AG）、胃肠化生（GIM）以及癌症的发生有关。不仅在胃癌（GC）中，而且在癌前病变中都发现了各种分子改变。幽门螺杆菌治疗似乎能改善AG和GIM，但仍存在争议。相比之下，包括荟萃分析在内的许多研究表明，根除幽门螺杆菌可降低GC的发生风险。与致癌作用相关的遗传和表观遗传改变所检测到的分子标志物在根除幽门螺杆菌后会发生逆转。这表明这些变化可能是识别癌症发生高危患者的一个重要因素。接受GC内镜治疗的患者发生异时性GC的风险很高。日本的一项随机对照试验得出结论，内镜切除术后预防性根除幽门螺杆菌应用于预防异时性GC的发生，但最近的回顾性研究并未显示出这种趋势。幽门螺杆菌治疗后癌前病变（分子改变）未逆转的患者代表了“不可逆转点”，可能发生GC的风险很高。因此，应考虑在癌前病变出现之前尽早根除幽门螺杆菌以预防GC的发生。
