Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2020; 26(26): 3834-3850
Published online Jul 14, 2020. doi: 10.3748/wjg.v26.i26.3834
Helicobacter pylori-induced inflammation masks the underlying presence of low-grade dysplasia on gastric lesions
Alba Panarese, Giovanni Galatola, Raffaele Armentano, Pedro Pimentel-Nunes, Enzo Ierardi, Maria Lucia Caruso, Francesco Pesce, Marco Vincenzo Lenti, Valeria Palmitessa, Sergio Coletta, Endrit Shahini
Alba Panarese, Endrit Shahini, Department of Gastroenterology and Digestive Endoscopy, National Institute of Gastroenterology "S De Bellis", Research Hospital, Castellana Grotte 70013, Italy
Raffaele Armentano, Maria Lucia Caruso, Sergio Coletta Department of Clinical Pathology, National Institute of Gastroenterology "S De Bellis", Research Hospital, Castellana Grotte 70013, Italy
Pedro Pimentel-Nunes, Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto 4200072, Portugal
Pedro Pimentel-Nunes, Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto 4200072, Portugal
Enzo Ierardi, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Francesco Pesce, Nephrology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Marco Vincenzo Lenti, First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
Valeria Palmitessa, Laboratory of Microbiology and Virology, National Institute of Gastroenterology "S De Bellis", Research Hospital, Castellana Grotte 70013, Italy
Endrit Shahini, Giovanni Galatola Gastroenterology Unit, Institute for Cancer Research and Treatment, Turin 10121, Italy
Author contributions: Panarese A and Shahini E were the guarantor and designed the study; Panarese A, Palmitessa V, Coletta S, and Shahini E participated in the acquisition, analysis, and interpretation of the data; Panarese A and Shahini E drafted the initial manuscript; all authors revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Committees on Ethics of Italy State National Institute of Gastroenterology “S De Bellis”.
Informed consent statement: Patients details have been removed from these case descriptions to ensure anonymity.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Alba Panarese, MD, Chief Doctor, Research Scientist, Department of Gastroenterology and Digestive Endoscopy, National Institute of Gastroenterology "S De Bellis", Research Hospital, Via Turi n. 27, Castellana Grotte 70013, Italy. alba.panarese@irccsdebellis.it
Received: March 18, 2020
Peer-review started: March 18, 2020
First decision: May 21, 2020
Revised: June 20, 2020
Accepted: June 30, 2020
Article in press: June 30, 2020
Published online: July 14, 2020

Helicobacter pylori (H. pylori) infection has been associated with a long-term risk of precancerous gastric conditions (PGC) even after H. pylori eradication.


To investigate the efficacy of High-Resolution White-Light Endoscopy with Narrow-Band Imaging in detecting PGC, before/after H. pylori eradication.


We studied 85 consecutive patients with H. pylori-related gastritis with/without PGC before and 6 mo after proven H. pylori eradication. Kimura-Takemoto modified and endoscopic grading of gastric intestinal metaplasia classifications, were applied to assess the endoscopic extension of atrophy and intestinal metaplasia. The histological result was considered to be the gold standard. The Sydney System, the Operative-Link on Gastritis-Assessment, and the Operative-Link on Gastric-Intestinal Metaplasia were used for defining histological gastritis, atrophy and intestinal metaplasia, whereas dysplasia was graded according to World Health Organization classification. Serum anti-parietal cell antibody and anti-intrinsic factor were measured when autoimmune atrophic gastritis was suspected.


After H. pylori eradication histological signs of mononuclear/polymorphonuclear cell infiltration and Mucosal Associated Lymphoid Tissue-hyperplasia, disappeared or decreased in 100% and 96.5% of patients respectively, whereas the Operative-Link on Gastritis-Assessment and Operative-Link on Gastric-Intestinal Metaplasia stages did not change. Low-Grade Dysplasia prevalence was similar on random biopsies before and after H. pylori eradication (17.6% vs 10.6%, P = 0.19), but increased in patients with visible lesions (0% vs 22.4%, P < 0.0001). At a multivariate analysis, the probability for detecting dysplasia after resolution of H. pylori-related active inflammation was higher in patients with regression or reduction of Mucosal Associated Lymphoid Tissue hyperplasia, greater alcohol consumption, and anti-parietal cell antibody and/or anti-intrinsic factor positivity [odds ratio (OR) = 3.88, 95% confidence interval (CI): 1.31-11.49, P = 0.01; OR = 3.10, 95%CI: 1.05-9.12, P = 0.04 and OR = 5.47, 95%CI: 1.33-22.39, P < 0.04, respectively].


High-Resolution White-Light Endoscopy with Narrow-Band Imaging allows an accurate diagnosis of Low-Grade Dysplasia on visible lesions after regression of H. pylori-induced chronic gastritis. Patients with an overlap between autoimmune/H. pylori-induced gastritis may require more extensive gastric mapping.

Keywords: Autoimmune gastritis, Dysplasia, Diagnosis, Malignancy, Gastric cancer, Symptoms, Signs

Core tip: Helicobacter pylori (H. pylori) infection is commonly responsible for precancerous gastric conditions. Heterogeneous long-term endoscopic follow-up studies (2-16 years), have shown conflicting results on the efficacy of H. pylori eradication in reducing the prevalence and histological progression of advanced precancerous gastric conditions. High-Resolution white-light endoscopy combined with narrow-band imaging allows for a more accurate diagnosis of gastric low-grade dysplasia when performed soon after H. pylori eradication. Subjects with an overlap between autoimmune and H. pylori-induced chronic gastritis should be considered to be at a higher risk for more severe gastric injury and they may require more extensive gastric mapping.