Prospective Study of Helicobacter pylori Eradication Therapy in Stage IE High-Grade Mucosa-Associated Lymphoid Tissue Lymphoma of the Stomach

2001 ◽  
Vol 19 (22) ◽  
pp. 4245-4251 ◽  
Author(s):  
Li-Tzong Chen ◽  
Jaw-Town Lin ◽  
Rong-Yaun Shyu ◽  
Chang-Ming Jan ◽  
Chi-Long Chen ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Prospective Study ◽  
Lymphoid Tissue ◽  
Remission Rate ◽  
Early Stage ◽  
Eradication Therapy ◽  
Stage I ◽  
High Grade ◽  
H Pylori

PURPOSE: High-grade mucosa-associated lymphoid tissue (MALT) lymphomas of the stomach are generally believed to be Helicobacter pylori–independent, autonomously growing tumors. However, anecdotal cases of regression of high-grade lymphomas after the cure of H pylori infection had been described. The present prospective study was conducted to evaluate the effect of anti–H pylori therapy in stage IE high-grade gastric MALT lymphomas. PATIENTS AND METHODS: Sixteen patients with H pylori infection and stage IE gastric high-grade MALT lymphoma consented to a brief antibiotic therapy as first-line treatment from June 1995 through April 2000. Then, patients underwent intensive endoscopic follow-up examinations (± endoscopic ultrasonography) with biopsy to evaluate tumor response. Patients with significant improvement of gross lesions that accompanied regression of large cells were followed up without additional treatment. Patients without significant improvement were immediately referred to systemic chemotherapy. RESULTS: Eradication of H pylori was achieved in 15 patients and was accompanied by rapid gross tumor regression and disappearance of large cells in 10. All 10 of these patients with early response had subsequent complete histologic remission of lymphoma. The complete remission rate was 62.5% (95% confidence interval, 35.8% to 89.1%). The response rate was not affected by the tumor grading (proportion of large blast cells within the tumor) but was adversely affected by the depth of tumor invasion. At a median follow-up of 43.5 months (range, 21.1 to 67.4 months), all 10 of these patients remained lymphoma-free. The median duration of complete response was 31.2 months (range, 14.4 to 49.1 months). CONCLUSION: These results suggest that high-grade transformation is not necessarily associated with the loss of H pyloridependence in early-stage MALT lymphomas of the stomach.

H pylori-positive gastric diffuse large B-cell lymphomas are potentially curable by H pylori eradication therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8093-8093
Author(s):  
S. H. Kuo ◽  
L. T. Chen ◽  
M. S. Wu ◽  
C. W. Lin ◽  
K. T. Kuo ◽  
...  
Keyword(s):  
B Cell ◽  
Remission Rate ◽  
Early Stage ◽  
Eradication Therapy ◽  
Additional Treatment ◽  
B Cell Lymphomas ◽  
H Pylori ◽  
Age Range ◽  
Large B Cell

8093 Background: We have recently demonstrated that early-stage gastric diffuse large B-cell lymphomas (DLBCLs) with MALToma, as well as their MALToma counterparts, may respond to H pylori eradication therapy (HPET). The present study was conducted to evaluate the effect of HPET in stage IE gastric DLBCLs without MALToma. Methods: Seven patients (4 men and 3 women; age range, 35 to 83 years) with H pylori infection and stage IE gastric DLBCL without MALToma received HPET as first-line treatment from June 2002 through May 2006. Additional immunohistochemical reaction with anticytokeratin was performed to exclude lymphoepithelial lesions (minimal MALToma components) in DLBCL. All patients received intensive endoscopic follow-up examinations with biopsy to evaluate tumor response. Patients with significant improvement of gross lesions that accompanied regression of tumor cells were followed up without additional treatment. Patients without significant improvement were immediately referred to systemic chemotherapy. Tumors that resolved to Wotherspoon grade 2 or less after successful HPET were considered as complete histologic remission. Results: Successful HPET was achieved in all patients. There were 5 patients with complete histologic remission. The complete remission rate was 71.4% (95% confidence interval, 45.1% to 97.7%). The median duration between HPET and complete histologic remission was 2.6 months (range, 1.1 to 5.7 months). At a median follow-up of 24.2 months (range, 5.7 to 56.8 months), all patients with complete histologic remission after HPET were alive and free of lymphoma. Conclusions: A substantial portion of early-stage gastric DLBCLs without MALToma remain H pylori-dependent and can potentially be cured by HPET. No significant financial relationships to disclose.

scholarly journals Helicobacter pylori eradication therapy is effective in the treatment of early-stage H pylori–positive gastric diffuse large B-cell lymphomas

Blood ◽  
2012 ◽  
Vol 119 (21) ◽  
pp. 4838-4844 ◽  
Author(s):  
Sung-Hsin Kuo ◽  
Kun-Huei Yeh ◽  
Ming-Shiang Wu ◽  
Chung-Wu Lin ◽  
Ping-Ning Hsu ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Confidence Interval ◽  
B Cell ◽  
De Novo ◽  
Early Stage ◽  
Eradication Therapy ◽  
B Cell Lymphomas ◽  
H Pylori ◽  
Large B Cell

Abstract An explorative study evaluates the efficacy of Helicobacter pylori (HP) eradication (HPE) therapy on early-stage gastric diffuse large B-cell lymphomas (DLBCLs) without features of mucosa-associated lymphoid tissue (MALT), the pure (de novo) DLBCLs, in comparison with its efficacy on high-grade transformed gastric MALT lymphomas, the DLBCL(MALT). In total, 50 patients of stage IE/IIE1 HP-positive gastric DLBCLs with frontline HPE treatment were included. HP infection was successfully eradicated in 100% (16/16) of the pure (de novo) DLBCL patients and 94.1% (32/34) of the DLBCL(MALT) patients. In total, 68.8% (11/16) of pure (de novo) DLBCL patients and 56.3% (18/32) of DLBCL(MALT) patients achieved complete pathologic remission (pCR) after HPE therapy. The median time to pCR was 2.1 months (95% confidence interval, 0.6%-3.7%) for pure (de novo) DLBCLs and 5.0 months (95% confidence interval, 2.8%-7.5%; P = .024) for DLBCL(MALT). At a median follow-up of 7.7 years, all patients with pCR after HPE therapy were alive and free of lymphomas, except for one patient with pure (de novo) DLBCL who died of lung cancer. Similar to DLBCL(MALT), a substantial portion of early-stage HP-positive gastric pure (de novo) DLBCLs remains HP-dependent and responds to antibiotic treatment. Prospective studies to validate the findings are warranted.

Helicobacter pylori and mucosa-associated lymphoid tissue: what's new

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 109-117 ◽  
Author(s):  
Sung-Hsin Kuo ◽  
Ann-Lii Cheng
Keyword(s):  
Malt Lymphoma ◽  
Lymphoid Tissue ◽  
Early Stage ◽  
Eradication Therapy ◽  
Gastric Malt Lymphoma ◽  
High Grade ◽  
First Line ◽  
Histological Evidence ◽  
H Pylori

AbstractLow-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach, gastric MALT lymphoma, is associated with Helicobacter pylori infection. The eradication of H pylori using antibiotics is successful in 60% to 80% of affected patients. In contrast to the previous paradigm, we and other investigators have shown that a certain proportion of patients with H pylori–positive early-stage diffuse large B-cell lymphoma (DLBCL) of the stomach with histological evidence of MALT lymphoma, including high-grade transformed gastric MALT lymphoma and gastric DLBCL(MALT), achieved long-term complete pathological remission (pCR) after first-line H pylori eradication therapy, indicating that the loss of H pylori dependence and high-grade transformation are separate events in the progression of gastric lymphoma. In addition, patients with H pylori–positive gastric DLBCL without histological evidence of MALT (gastric pure DLBCL) may also respond to H pylori eradication therapy. A long-term follow-up study showed that patients who achieved pCR remained lymphoma free. Gastric MALT lymphoma is indirectly influenced by H pylori infection through T-cell stimulation, and recent studies have shown that H pylori–triggering chemokines and their receptors, H pylori–associated epigenetic changes, H pylori–regulated miRNA expression, and tumor infiltration by CD4+CD25+ regulatory T cells contribute to lymphomagenesis of gastric MALT lymphoma. Recent studies have also demonstrated that the translocation of CagA into B lymphocytes inhibits apoptosis through p53 accumulation, BAD phosphorylation, and the up-regulation of Bcl-2 and Bcl-XL expression. In gastric MALT lymphoma, CagA may stimulate lymphomagenesis directly, through the regulation of signal transduction, and intracellular CagA is associated with H pylori dependence. These findings represent a substantial paradigm shift compared with the classical theory of H pylori–reactive T cells contributing indirectly to the development of MALT lymphoma. In conclusion, a wide range of H pylori–related gastric lymphomas have been identified. The use of antibiotics as the sole first-line therapy for early-stage gastric pure DLBCL requires validation in a prospective study. The clinical and biological significance of the CagA oncoprotein in the lymphomagenesis of gastric MALT lymphoma warrants further study.

Nuclear Expression of BCL10 or Nuclear Factor Kappa B Predicts Helicobacter pylori–Independent Status of Early-Stage, High-Grade Gastric Mucosa-Associated Lymphoid Tissue Lymphomas

2004 ◽  
Vol 22 (17) ◽  
pp. 3491-3497 ◽  
Author(s):  
Sung-Hsin Kuo ◽  
Li-Tzong Chen ◽  
Kun-Huei Yeh ◽  
Ming-Shiang Wu ◽  
Hui-Chen Hsu ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastric Mucosa ◽  
Lymphoid Tissue ◽  
Nuclear Factor Kappa B ◽  
Early Stage ◽  
Gastric Malt Lymphoma ◽  
Nuclear Factor ◽  
High Grade ◽  
Nuclear Expression ◽  
H Pylori

Purpose A high percentage of early-stage, high-grade gastric mucosa-associated lymphoid tissue (MALT) lymphomas remain Helicobacter pylori dependent. t(11;18)(q21;q21), a genetic aberration highly predictive of H pylori–independent status in low-grade gastric MALT lymphoma, is rarely detected in its high-grade counterpart. This study examined whether nuclear expression of BCL10 or nuclear factor kappa B (NF-κB) is useful in predicting H pylori–independent status in patients with stage IE high-grade gastric MALT lymphomas. Patients and Methods Twenty-two patients who had participated in a prospective study of H pylori eradication for stage IE high-grade gastric MALT lymphomas were studied. The expression of BCL10 and NF-κB in pretreatment paraffin-embedded lymphoma tissues was evaluated by immunohistochemistry and confocal immunofluorescence microscopy. The presence of t(11;18)(q21;q21) was identified by a multiplex reverse transcriptase polymerase chain reaction of the API2-MALT1 chimeric transcript. Results Aberrant nuclear expression of BCL10 was detected in seven (87.5%) of eight H pylori–independent and in none of 14 H pylori–dependent high-grade gastric MALT lymphomas (P < .001). All seven patients with nuclear BCL10 expression had nuclear expression of NF-κB, compared with only two of 15 patients without nuclear BCL10 expression (P = .002). As a single variable, the frequency of nuclear expression of NF-κB was also significantly higher in H pylori–independent tumors than in H pylori–dependent tumors (seven of eight [87.5%] v two of 15 [12.3%]; P = .002). The API2-MALT1 fusion transcript was detected in only one (12.5%) of eight H pylori–independent lymphomas. Conclusion Nuclear expression of BCL10 or NF-κB is highly predictive of H pylori–independent status in high-grade gastric MALT lymphoma, and coexpression of these two markers in the nuclei is frequent.

scholarly journals The Reduction in Gastric Atrophy after Helicobacter pylori Eradication Is Reduced by Treatment with Inhibitors of Gastric Acid Secretion

2019 ◽  
Vol 20 (8) ◽  
pp. 1913 ◽  
Author(s):  
Ryota Niikura ◽  
Yoku Hayakawa ◽  
Yoshihiro Hirata ◽  
Keiji Ogura ◽  
Mitsuhiro Fujishiro ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Drug Use ◽  
Intestinal Metaplasia ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Eradication Therapy ◽  
Gastric Atrophy ◽  
H Pylori ◽  
Surveillance Endoscopy

Background: Helicobacter pylori (H. pylori) eradication therapy may improve gastric atrophy and intestinal metaplasia, but the results of previous studies have not always been consistent. The aim of this study was to compare the histological changes of intestinal metaplasia and gastric atrophy among the use of acid-suppressing drugs after H. pylori eradication. Methods: A cohort of 242 patients who underwent successful eradication therapy for H. pylori gastritis and surveillance endoscopy examination from 1996 to 2015 was analyzed. Changes in the histological scores of intestinal metaplasia and atrophy according to drug use (proton-pump inhibitors (PPIs), H2 receptor antagonists (H2RAs), and non-acid suppressant use) were evaluated in biopsies of the antrum and corpus using a generalized linear mixed model in all patients. Results: The mean follow-up period and number of biopsies were 5.48 ± 4.69 years and 2.62 ± 1.67 times, respectively. Improvement in the atrophy scores of both the antrum (p = 0.042) and corpus (p = 0.020) were significantly superior in patients with non-acid suppressant drug use compared with those of PPI and H2RA use. Metaplasia scores in both the antrum and corpus did not improve in all groups, and no significant differences were observed among groups in the antrum (p = 0.271) and corpus (p = 0.077). Conclusions: Prolonged acid suppression by PPIs or H2RAs may limit the recovery of gastric atrophy following H. pylori eradication.

Complete Remission of Primary High-Grade B-Cell Gastric Lymphoma After Cure of Helicobacter pylori Infection

2001 ◽  
Vol 19 (7) ◽  
pp. 2041-2048 ◽  
Author(s):  
Andrea Morgner ◽  
Stephan Miehlke ◽  
Wolfgang Fischbach ◽  
Wolfgang Schmitt ◽  
Hans Müller-Hermelink ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Complete Remission ◽  
B Cell ◽  
Gastric Lymphoma ◽  
Eradication Therapy ◽  
Lymph Node Involvement ◽  
Low Grade ◽  
Resected Stomach ◽  
High Grade ◽  
H Pylori

PURPOSE: Treatment of low-grade gastric mucosa-associated lymphoid tissue lymphoma by eradication of Helicobacter pylori is reported to result in complete lymphoma remission in approximately 75% of cases. The effect that cure of the infection has on the course of a primary high-grade gastric lymphoma is largely uncertain. The aim of this study was to report the effect of cure of H pylori infection exerted in patients with high-grade B-cell gastric lymphoma. PATIENTS AND METHODS: Eight patients (4 males and 4 females; age range, 26 to 85 years) with H pylori infection and high-grade lymphoma received eradication therapy before planned treatment. The effect of H pylori eradication on the course of high-grade lymphoma was assessed by analysis of surgical specimens (n = 2) or endoscopic biopsies (n = 6). RESULTS: H pylori eradication was successful in all patients and led to complete remission of the lymphoma in seven patients. One patient has experienced partial remission. Two patients were referred to surgery, one of whom (stage II1E) had lymph node involvement, and the histologic work-up of the resected stomach revealed residual infiltrates of a low-grade lymphoma, which prompted consolidation chemotherapy. In one patient (initially stage I1E), abdominal lymphoma developed 6 months after eradication therapy, which regressed completely after chemotherapy. In four patients, no further treatment was given. Six patients continue in complete remission (range, 6 to 66 months). CONCLUSION: Primary high-grade B-cell gastric lymphoma in stages IE through IIE1 associated with H pylori may regress completely after successful cure of the infection. Prospective trials are needed to investigate this treatment in larger numbers of patients.

scholarly journals Detection of Helicobacter pylori in Stool Specimens by PCR and Antigen Enzyme Immunoassay

1998 ◽  
Vol 36 (9) ◽  
pp. 2772-2774 ◽  
Author(s):  
Athanasios Makristathis ◽  
Eva Pasching ◽  
Kurt Schütze ◽  
Margit Wimmer ◽  
Manfred L. Rotter ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Enzyme Immunoassay ◽  
Eradication Therapy ◽  
Diagnostic Tools ◽  
Pcr Assay ◽  
Highly Sensitive ◽  
Stool Specimens ◽  
H Pylori ◽  
Seminested Pcr

A highly sensitive seminested PCR assay to detectHelicobacter pylori DNA in feces was developed. PCR with stool specimens and a novel antigen enzyme immunoassay (EIA) forH. pylori detection in feces were evaluated as diagnostic tools and in follow-up with samples from 63 infected and 37 noninfected persons. Infected individuals received eradication therapy followed by endoscopic follow-up 35 days after the start of treatment. At that time, a second stool specimen was obtained from 55 of these patients. Before eradication, the sensitivity of PCR was 93.7% and that of EIA 88.9%. Specificities were 100 and 94.6%, respectively. Of the 55 follow-up specimens, 41 originated from patients from whom H. pylori had been eradicated. Of these, 21 were still positive by PCR and 13 were positive by EIA, indicating that 1 month may be too short a period for follow-up evaluation of stool specimens by these tests.

scholarly journals Helicobacter pylori and Gastric Metaplasia: Their Status after Eradication Therapy

1970 ◽  
Vol 15 (2) ◽  
pp. 59-63
Author(s):  
Maleeha Hussain ◽  
Mian Ahmad Mashud ◽  
Hazera Khatun ◽  
Tareak Al Nasir
Keyword(s):  
Duodenal Ulcer ◽  
Helicobacter Pylori ◽  
Eradication Therapy ◽  
Ulcer Recurrence ◽  
Ulcer Margin ◽  
Gastric Metaplasia ◽  
H Pylori ◽  
The Relationship

This study was carried out with an aim to investigate the relationship between gastricmetaplasia with H. pylori and the effect of eradication therapy. A total of 210 patients withhistory of dyspepsia were included in the study of which 50 were enrolled in the eradicationtherapy. After the eradication therapy 35 patients came for follow-up endoscopy. Pairedendoscopic biopsies were taken from antrum and duodenal ulcer margin and were examined forH. pylori and for duodenitis and gastric metaplasia. Gastric metaplasia was significantlyassociated with H. pylori. After eradication H. pylori showed further extension of gastricmetaplasia. It can be recommended that these patients can be further followed up to see thecourse of gastric metaplasia and what impact it has on ulcer recurrence and re-infection.doi: 10.3329/taj.v15i2.3908TAJ December 2002; Vol.15(2):59-63

Sign in / Sign up

Export Citation Format

Share Document