Fischbach Wolfgang
Medizinische Klinik II und Klinik für Palliativmedizin, Klinikum Aschaffenburg, Academic Teaching Hospital of the University of Würzburg, Am Hasenkopf, D-63739 Aschaffenburg, Germany.
Best Pract Res Clin Gastroenterol. 2014 Dec;28(6):1069-77. doi: 10.1016/j.bpg.2014.09.006.
Gastrointestinal lymphoma represent a heterogenous group with differences in pathogenesis, treatment and prognosis. Gastric MALT lymphoma is the most common entity. Helicobacter pylori has been identified as its decisive pathogenetic factor. Once a definitive diagnosis has been established a staging procedure is obligatory for defining the stage of disease. H. pylori eradication is the treatment of choice in all MALT lymphoma patients being infected by the bacterium. In some 70-80% of patients with stages I/II complete regression of the lymphoma will develop after successful eradication of H. pylori. Another 20% of patients will reveal minimal histological residuals after eradication. They can be successfully managed by a watch-and-wait strategy if initial endoscopic abnormalities disappear. At present, it is unclear if this strategy can be also offered to patients with persisting minimal endoscopic abnormalities. Why eradication therapy is effective in some patients with negative H. pylori status is highly speculative at present. Non-responders to H. pylori therapy are transferrred to radiotherapy in stages I/II or to immuno-chemotherapy in stages III/IV.
胃肠道淋巴瘤是一组异质性疾病，在发病机制、治疗和预后方面存在差异。胃黏膜相关淋巴组织（MALT）淋巴瘤是最常见的类型。幽门螺杆菌已被确定为其决定性的致病因素。一旦确诊，必须进行分期检查以确定疾病的分期。对于所有感染该细菌的MALT淋巴瘤患者，根除幽门螺杆菌是首选治疗方法。在大约70%-80%的I/II期患者中，成功根除幽门螺杆菌后淋巴瘤将完全消退。另外20%的患者在根除后会有微小的组织学残留。如果最初的内镜异常消失，可通过观察等待策略成功处理。目前尚不清楚对于持续存在微小内镜异常的患者是否也可采用该策略。目前，根除治疗为何对一些幽门螺杆菌检测阴性的患者有效仍极具推测性。对幽门螺杆菌治疗无反应的患者，I/II期转至放疗，III/IV期转至免疫化疗。
