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

Abstract

Prevailing evidence declares that Helicobacter pylori (H. pylori) eradication therapy could shift precancerous gastric conditions (PGC) and positively confines gastric cancer (GC) risk during long-term endoscopic follow-up. Nonetheless, there is a yet unsolved controversy regarding the best-individualized surveillance strategies following H. pylori eradication, based on malignant risk stratification. This last dispute is due to the uncertainty of contemporary evidence and the role of H. pylori inflammatory changes in underestimating PGC at the index endoscopy. However, the current state of the art suggests that it is reasonable that high-quality endoscopy with histological assessment for the most accurate diagnosis of PGC may be delayed in selected high-risk patients without alarm signs for malignancy, following the eradication of H. pylori. Notwithstanding, these aspects need to be further examined in the next future to establish and optimize the most beneficial and cost-effective strategies for recognizing and managing H. pylori-positive patients with PGC in the short- and long-term follow-up. Accordingly, additional studies are yet required to sharpen the hazard stratification of patients with the greatest chance of GC evolution, also recognizing the evolving racial, ethnic, immigration factors and the necessity of novel biomarkers to limit GC development or accomplish a diagnosis of malignancy at an early stage.

Keywords: Helicobacter pylori; Endoscopic surveillance; Atrophic gastritis; Intestinal metaplasia; Dysplasia; Gastric cancer

Core Tip: Prevailing evidence affirms that Helicobacter pylori (H. pylori) eradication therapy could shift precancerous gastric conditions and positively confines gastric cancer risk during long-term endoscopic follow-up. Nonetheless, there is a yet unsolved dispute concerning the most useful individualized surveillance strategies following H. pylori eradication, based on malignant risk stratification. These aspects should be examined in the next future to establish and optimize the most cost-effective strategies for recognizing and managing H. pylori-positive patients with precancerous gastric conditions in the short- and long-term follow-up. Accordingly, new studies are required to sharpen the hazard stratification of patients with the greatest chance of progressing into gastric cancer.