Gut Liver.  2017 Mar;11(2):209-215. 10.5009/gnl16224.

Dynamic Changes in Helicobacter pylori Status Following Gastric Cancer Surgery

• Yoon K
• Kim N
• Kim J
• Lee JW
• Lee HS
• Lee JC
• Yoon H
• Shin CM
• Park YS
• Ahn SH
• Park DJ
• Kim HH
• Lee YJ
• Lee KH
• Kim YH
• Lee DH

• KMID: 2412186
• DOI: http://doi.org/10.5009/gnl16224

Abstract

BACKGROUND/AIMS
Helicobacter pylori eradication is recommended in patients with early gastric cancer. However, the possibility of spontaneous regression raises a question for clinicians about the need for "retesting" postoperative H. pylori status.
METHODS
Patients who underwent curative gastrectomy at Seoul National University Bundang Hospital and had a positive H. pylori status without eradication therapy at the time of gastric cancer diagnosis were prospectively enrolled in this study. H. pylori status and atrophic gastritis (AG) and intestinal metaplasia (IM) histologic status were assessed pre- and postoperatively.
RESULTS
One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently positive for H. pylori, and 60 (42.9%) showed spontaneous negative conversion at least once during follow-up. Of these 60 patients, eight (13.3%) showed more complex postoperative dynamic changes between negative and positive results. The spontaneous negative conversion group showed a trend of having more postoperative IM compared to the persistent H. pylori group.
CONCLUSIONS
A high percentage of spontaneous regression and complex dynamic changes in H. pylori status were observed after partial gastrectomy, especially in individuals with postoperative histological IM. It is better to consider postoperative eradication therapy after retesting for H. pylori.

Keyword

Helicobacter pylori; Postoperation; Eradication

MeSH Terms

Aged
Female
Gastrectomy/*methods
Gastritis, Atrophic/diagnosis
Helicobacter Infections/*microbiology
*Helicobacter pylori
Humans
Intestines/pathology
Male
Metaplasia/diagnosis
Middle Aged
Postoperative Complications/diagnosis/*microbiology
Postoperative Period
Preoperative Period
Prospective Studies
Seoul
Stomach Neoplasms/*microbiology/pathology/*surgery
Treatment Outcome