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

Jiro Watari, Nancy Chen, Peter S. Amenta, Hirokazu Fukui, Tadayuki Oshima, Toshihiko Tomita, Hiroto Miwa, Kheng Jim Lim, Kiron M. Das

Research output: Contribution to journalReview articlepeer-review

199 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)5461-5473
Number of pages13
JournalWorld Journal of Gastroenterology
Volume20
Issue number18
DOIs
StatePublished - May 14 2014
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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