Surveillance strategies for precancerous gastric conditions after Helicobacter pylori eradication: There is still need for a tailored approach

Table 1 Characteristics of patients included in the eleven selected studies applying endoscopic surveillance shorter than two years for the evaluation of precancerous gastric conditions following Helicobacter pylori eradication

	van der Hulst RW et al[2], 1997	Tucci A et al[3], 1998	Sung JJ et al[4], 2000	Annibale B et al[5], 2000	Ohkusa T et al[6], 2001	Oda Y et al[7], 2004	Annibale B et al[8], 2002	Yamada T et al[9], 2003	Iacopini F et al[10], 2003	Wambura C et al[11], 2004	Panarese et al[12], 2020
Study	Prospective	Retrospective	Prospective, randomized, placebo controlled trial	Observational, prospective study	Single-blind, uncontrolled prospective trial	Retrospective	Retrospective	Retrospective	Observational, prospective study	Observational, prospective study	Observational, prospective study
Country	Netherlands	Italy	China	Italy	Japan	Japan	Italy	Japan	Italy	Japan	Italy
Mean age, yr	49.2	50	51 (Median)	48.7	54	51	46 (Median)	52.6	55	51.2	56.1
Male, %	54	50	49.5	14.3	73	89.8	22.5	64.4	75	74.7	37.6
Overlap AAG	NA	0	NA	48.6	NA	NA	55	NA	NA	NA	26.3
Mean follow-up, mo	12	12	12	6-12	12-15	1-2	6-12	22	12	12	6
Total, n	106	10	226	25	115	59	40	87	40	107	85
Resolution of gastric acute/chronic inflammation in the antrum n (%)	S	10/10 (100)	S	25/25 (100)	NA	S	S	S	S	S	81/85 (95.3)
Resolution of gastric acute/chronic inflammation in the corpus, n (%)	S	NA	S	25/25 (100)	NA	S	S	S	S	S	81/85 (85.3)
Resolution of gastric acute/chronic inflammation in the fundus n (%)	NA	10/10 (100)	NA	NA	NA	NA	NA	NA	NA	NA	NA
Improvement of AG in the antrum, n (%)	NS	NS	NS	NS	34/38 (89)	NS	NS	NS	NS	S	NS
Improvement of AG in the corpus, n (%)	NS	NA	NS	NS	34/38 (89)	NS	8/40 (20) AG reversed	S	NA	S	NS
Improvement of AG in the fundus, n (%)	NA	S	NA	NA	NA	NA	NA	S	NA	NA	NA
Improvement of IM in the antrum, n (%)	NS	S	S	NS	28/46 (61)	NS	NS	NS	NS	NS	NS
Improvement of IM in the corpus, n (%)	NS	NA	NS	NS	28/46 (61)	NS	NS	NS	NA	S	NS
Improvement of IM in the fundus, n (%)	NA	NS	NA	NA	NA	NA	NA	NA	NA	S	NA
ECL pattern regression, n (%)	NA	NA	NA	8/15 (53.3) patients with AG in the body (12 mo after curing H. pylori)	NA	NA	NA	NA	NA	NA	36/39 (92.3)
LGD regression (or progression), n (%)	NA	NA	NA	1/1 (100) regression in a patient with AG in the body (12 mo after curing H. pylori)	NA	NA	NA	NA	NA	NA	The proportion of patients with histological diagnosis of LGD on random biopsies did not significantly change after H. pylori eradication [15 (17.6) vs 9 (10.6)]; the detection of LGD on visible lesions significantly increased after H. pylori eradication [0 (0) vs 19 (22.3)]
Conclusions	The usefulness of H. pylori eradication to regress precancerous lesions following 12 mo follow-up is uncertain	The natural history of AG can be modified by the eradication of H.pylori	At 12 mo, H. pylori eradication can block the histological progression of gastric mucosa alterations	H. pylori infection may be cured in patients with AG in the body with a partial reversing of its adverse outcomes on acid secretion and body ECL cell hyperplasia	After successful H. pylori eradication, precancerous lesions improved in most patients	After H. pylori eradication, neutrophil infiltration in the gastric mucosa improved relatively soon, while AG and IM did not display such tendency	In patients with AG of the body and H. pylori infection, the assessment of histological data after eradication is essential. In patients with maintaining body atrophy after H. pylori elimination, there is no association with the reversal of body atrophy, even at long-term surveillance	AG in the corpus can be improved after 12 mo following H. pylori eradication	H. pylori positive patients with AG, the overall oxidative damage of the gastric mucosa is more severe than that in H. pylori positive patients with nonatrophic gastritis	Eradication of H. pylori may decrease the risk of GC, due to the importance of H. pylori infection in the contributory role of gastritis in COX-2 expression and the dissociation between the processes of regression in gastritis and the reduction in COX-2	HR-WLE with NBI can be more reliable in diagnosing LGD on visible lesions after H. pylori elimination, presumably due to the removal of the underlying confounding effects of inflammatory and mucosal lymphoproliferative changes induced by H. pylori chronically active infection. Aged patients and those with autoimmune diseases (especially AAG) could be at higher risk for H. pylori persistent infection

AAG: Autoimmune gastritis; AG: Atrophic gastritis; IM: Intestinal metaplasia; ECL: Enterochromaffin-like cell; LGD: Low-grade dysplasia; H. pylori: Helicobacter pylori; NA: Not available; NS: Not significant; S: Significant improvement; HR-WLE: High-resolution wight light endoscopy; NBI: Narrow band imaging.