Nam Su Youn, Park Bum Joon, Ryu Kum Hei, Nam Ji Hyung
aDepartment of Gastroenterology, Center for Gastric Cancer, Kyungpook National University Medical Center, Daegu bDepartment of Internal Medicine, Center for Cancer Prevention & Detection, National Cancer Center, Goyang, Korea.
Eur J Gastroenterol Hepatol. 2016 Apr;28(4):449-54. doi: 10.1097/MEG.0000000000000553.
Western guidelines recommend Helicobacter pylori eradication in H. pylori-associated gastric polyps, but Korean medical insurance does not approve its eradication. The aim of this study is to evaluate the effect of H. pylori eradication on gastric polyps.
Participants in a large screening cohort underwent baseline and follow-up esophagogastroduodenoscopy and H. pylori testing. The association between gastric polyps and H. pylori was estimated using odds ratios (ORs) adjusted for confounding factors and 95% confidence intervals (CIs). The effect of H. pylori eradication on the fate of polyps was also evaluated.
The screening cohort included 7603 participants (605 gastric polyps: 529 hyperplastic polyps, 63 fundic gland polyps, and 13 adenomas). H. pylori infection showed a positive association with hyperplastic polyps (OR 2.01; 95% CI 1.66-2.41), but was inversely related to fundic gland polyps (OR 0.05; 95% CI 0.02-0.17). Removed polyps by biopsy or endoscopic resection or tiny polyps less than 3 mm at baseline and positive conversion of H. pylori at follow-up were excluded. A total of 7060 persons were finally included to evaluate the effect of H. pylori eradication on the gastric polyp. Successful H. pylori eradication (OR 0.52; 95% CI 0.35-0.77) and persistent H. pylori-negative status (OR 0.59; 95% CI 0.46-0.76) reduced the risk of hyperplastic polyps compared with the persistent H. pylori-positive group. Successful H. pylori eradication markedly induced the disappearance of hyperplastic polyps compared with the persistent H. pylori-positive group (85.0 vs. 29.0%, P=0.001).
H. pylori infection increased the risk of hyperplastic polyps in both cross-sectional and longitudinal settings, and its eradication induced regression of hyperplastic polyps.
西方指南推荐根除幽门螺杆菌以治疗幽门螺杆菌相关胃息肉，但韩国医疗保险不批准其根除治疗。本研究旨在评估根除幽门螺杆菌对胃息肉的影响。
大型筛查队列中的参与者接受了基线和随访时的食管胃十二指肠镜检查及幽门螺杆菌检测。使用经混杂因素调整的比值比（OR）和95%置信区间（CI）评估胃息肉与幽门螺杆菌之间的关联。还评估了根除幽门螺杆菌对息肉转归的影响。
筛查队列包括7603名参与者（605个胃息肉：529个增生性息肉、63个胃底腺息肉和13个腺瘤）。幽门螺杆菌感染与增生性息肉呈正相关（OR 2.01；95%CI 1.66 - 2.41），但与胃底腺息肉呈负相关（OR 0.05；95%CI 0.02 - 0.17）。通过活检或内镜切除去除的息肉或基线时小于3毫米的微小息肉以及随访时幽门螺杆菌转为阳性的情况被排除。最终纳入7060人以评估根除幽门螺杆菌对胃息肉的影响。与持续幽门螺杆菌阳性组相比，成功根除幽门螺杆菌（OR 0.52；95%CI 0.35 - 0.77）和持续幽门螺杆菌阴性状态（OR 0.59；95%CI 0.46 - 0.76）降低了增生性息肉的风险。与持续幽门螺杆菌阳性组相比，成功根除幽门螺杆菌显著促使增生性息肉消失（85.0%对29.0%，P = 0.001）。
幽门螺杆菌感染在横断面和纵向研究中均增加了增生性息肉的风险，根除幽门螺杆菌可使增生性息肉消退。
