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World J Gastroenterol. May 28, 2018; 24(20): 2163-2172
Published online May 28, 2018. doi: 10.3748/wjg.v24.i20.2163
Characteristics and predictors of gastric cancer after Helicobacter pylori eradication
Satoki Shichijo, Yoshihiro Hirata
Satoki Shichijo, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan
Yoshihiro Hirata, Division of Advanced Genome Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
Author contributions: Shichijo S drafted the article; and Hirata Y critically revised and approved the final article.
Supported by (partly) JSPS KAKENHI, No. 17K09346 and No. 16K09279.
Conflict-of-interest statement: The authors declare that no competing interests exist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoshihiro Hirata, MD, PhD, Associate Professor, Division of Advanced Genome Medicine, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan. yohirata@ims.u-tokyo.ac.jp
Telephone: +81-3-64092335 Fax: +81-3-64092336
Received: March 27, 2018
Peer-review started: March 28, 2018
First decision: April 19, 2018
Revised: May 4, 2018
Accepted: May 18, 2018
Article in press: May 18, 2018
Published online: May 28, 2018
Abstract

Helicobacter pylori (H. pylori) eradication can reduce gastric cancer. However, gastric cancer still develops after eradication, and cases who received eradication therapy are increasing. In this study, we have reviewed the characteristics and predictors of primary gastric cancer developing after H. pylori eradication. In terms of the characteristics, endoscopic, histologic, and molecular characteristics are reported. Endoscopically, gastric cancer after eradication is often depressed-type and shows a gastritis-like appearance, which sometimes makes the diagnosis difficult. Histologically, most gastric cancer after eradication is intestinal type, and non-neoplastic epithelium, also called epithelium with low-grade atypia, is frequently seen over the tumor, which is presumably the cause of the endoscopic gastritis-like appearance. As for molecular characteristics, some markers, such as Ki67, MUC2, and Wnt5a expression, are lower in cancer from patients in whom H. pylori has been eradicated. In terms of predictors, several Japanese studies have reported that severe endoscopic atrophy at eradication is a risk factor for gastric cancer development. Histologic intestinal metaplasia, especially in the corpus, and long-term use of proton pump inhibitors, are also reported as risk factors for gastric cancer after H. pylori eradication. These studies on the characteristics and predictors of gastric cancer development will become the cornerstone for establishing a novel surveillance program based on the gastric cancer risk stratification specific to H. pylori-eradicated patients.

Keywords: Gastric cancer, Eradication, Characteristic, Helicobacter pylori, Predictor

Core tip: Gastric cancer develops even after successful Helicobacter pylori (H. pylori) eradication therapy. With the prevalence of eradication therapy, occurrence rates of gastric cancer detected after eradication are increasing and this is becoming an important clinical issue. We review the characteristics and predictors of primary gastric cancer after H. pylori eradication, and discuss the risk stratification of gastric cancer after eradication.