Oncol Rep. 2013 Jul;30(1):299-303. doi: 10.3892/or.2013.2472.

Spontaneous clearance of Helicobacter pylori after pylorus-preserving gastrectomy for gastric cancer.

Miyashita T, Miwa K, Inokuchi M, Nakagawara H, Tajima H, Takamura H, Ninomiya I, Kitagawa H, Fushida S, Fujimura T, Hattori T, Ohta T.

Department of Gastroenterologic Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan. tomoharumiya@gmail.com

Abstract:

Background/Aims: Residual mucosa in the gastric stump after Pylorus-sparing gastrectomies (PSG), such as transectional gastrectomy, pylorus-preserving gastrectomy, and local resection is considered a risk factor for the development of gastric stump carcinoma (GSC). Duodenogastric reflux (DGR) and Helicobacter pylori infection are suspected to contribute to the development of GSC. To investigate the prevalence of H. pylori in the residual stomach after PSG for gastric cancer and to assess factors associated with the presence of H. pylori.

Methods: We investigated 72 patients who had undergone PSG at least 1 year earlier and were confirmed to be positive for H. pylori infection on presurgical endoscopic biopsy. The extent of DGR, the prevalence of H. pylori infection on H. pylori stool antigen (HpSA) tests and the severity of gastritis were analyzed in these post-PSG patients.

Results: None of these patients had DGR, as shown by 99mTc-PMT. Of the 72 post-PSG patients, 33 (46%) were positive for HpSA. The prevalence of H. pylori infection was significantly lower after surgery than before surgery. The endoscopic severity of remnant gastritis, as well as histological inflammation and activity, were higher in H. pylori-positive patients than in H. pylori-negative patients.

Conclusions: Some patients who undergo PSG and are negative for DGR experience spontaneous clearance of H. pylori infection.

PMID: 23673508

 

SUPPLEMENT:

Both H. pylori and bile acids induce strong inflammation to gastric mucosa through production of various inflammatory molecules (Fig 1). Histological gastritis and endoscopic gastritis are related with H. pylori infection and bile reflux, respectively. Both H. pylori infection and bile reflux play important roles in the development of GSC. PSG enable to eradicate H. pylori and prevent bile reflux, suggesting that these operations would inhibit carcinogenesis (Fig 2).

Fig1

 

 

Fig2

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