Helicobacter pylori associated chronic gastritis,clinical syndromes,precancerous lesions,and pathogenesis of gastric cancer development

作     者：Jiro Watari Nancy Chen Peter S Amenta Hirokazu Fukui Tadayuki Oshima Toshihiko Tomita Hiroto Miwa Kheng-Jim Lim Kiron M Das 

作者机构：Division of GastroenterologyDepartment of Internal MedicineHyogo College of MedicineNishinomiya 663-8501Japan Division of Gastroenterology and HepatologyDepartments of Medicine and PathologyRobert Wood Johnson Medical SchoolRutgersCancer Institute of New JerseyNew BrunswickNJ 08903United States 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2014年第20卷第18期

页      面：5461-5473页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by Grant NIDDK RO1DK63618 to KMD from the National Institutes of Health Bethesda MD 

主　　题：Helicobacter pylori Gastric atrophy Intestinal metaplasia Gastric cancer Eradication Prevention Molecular alteration 

摘      要：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.