Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
PLoS One. 2016 Oct 5;11(10):e0163700. doi: 10.1371/journal.pone.0163700. eCollection 2016.
The effect of H. pylori eradication in gastric cancer prevention can be attributed to the improvement of atrophic gastritis, which is a known risk of gastric cancer. However, gastric cancer has also been diagnosed after long-term H. pylori eradication. This study aimed to clarify the association between gastric atrophy and gastric cancer after H. pylori eradication, including its clinicopathological features.
A total of 55 consecutive patients with 64 early gastric cancers (EGCs) diagnosed after H. pylori eradication were enrolled. The degree of endoscopic atrophy and the histological degrees of mononuclear cell infiltration, atrophy, and metaplasia in the corpus and adjacent mucosa of the EGCs were determined and scored.
The majority of EGCs (63/64) were located within the endoscopically assessed atrophic mucosa or along the atrophic border. The adjacent mucosa of the EGCs presented significantly higher degrees of all histological parameters than in the corpus (mononuclear cell infiltration, 0.86+/-0.09 vs. 0.51+/-0.11, P = 0.016; atrophy, 1.77+/-0.13 vs. 0.65+/-0.14, P<0.0001; metaplasia, 1.68+/-0.13 vs. 0.48+/-0.1, P<0.0001). The degree of endoscopic atrophy improved in the patients with longer post-H. pylori eradication periods; however, this trend was not observed for the histological parameters, and high degrees of atrophy and metaplasia were observed in the adjacent mucosa of the EGCs compared with the corpus during all periods (all P<0.05). The histological degrees of atrophy and metaplasia in the adjacent mucosa were particularly higher in the patients who underwent eradication due to gastric ulcers.
Severe gastric atrophy remained in the adjacent mucosa of the EGCs after H. pylori eradication, which may be linked to gastric carcinogenesis.
幽门螺杆菌（H. pylori）根除对胃癌预防的作用可归因于萎缩性胃炎的改善，而萎缩性胃炎是胃癌的已知危险因素。然而，在长期根除 H. pylori 后也诊断出胃癌。本研究旨在阐明 H. pylori 根除后胃萎缩与胃癌之间的关系，包括其临床病理特征。
共纳入 55 例因 H. pylori 根除而诊断的 64 例早期胃癌（EGC）连续患者。确定并评分 EGC 在内镜下评估的萎缩程度以及其 corpus 和相邻黏膜中的单核细胞浸润、萎缩和化生的组织学程度。
大多数 EGC（63/64）位于内镜评估的萎缩黏膜内或沿萎缩边界。EGC 的相邻黏膜具有显著更高程度的所有组织学参数，高于 corpus（单核细胞浸润，0.86+/-0.09 比 0.51+/-0.11，P = 0.016；萎缩，1.77+/-0.13 比 0.65+/-0.14，P<0.0001；化生，1.68+/-0.13 比 0.48+/-0.1，P<0.0001）。在根除 H. pylori 后时间较长的患者中，内镜下的萎缩程度得到改善；然而，这种趋势并未在组织学参数中观察到，在所有时期，EGC 的相邻黏膜均表现出比 corpus 更高的萎缩和化生程度（均 P<0.05）。在因胃溃疡而进行根除的患者中，相邻黏膜的萎缩和化生程度尤其更高。
H. pylori 根除后 EGC 的相邻黏膜仍存在严重的胃萎缩，这可能与胃癌发生有关。
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