Article

Factors predicting progression of gastric intestinal metaplasia: Results of a randomised trial on Helicobacter pylori eradication

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, 00, Hong Kong
Gut (Impact Factor: 13.32). 10/2004; 53(9):1244-9. DOI: 10.1136/gut.2003.034629
Source: PubMed

ABSTRACT Gastric intestinal metaplasia (IM) is generally considered to be a precancerous lesion in the gastric carcinogenesis cascade. This study identified the risk factors associated with progression of IM in a randomised control study.
A total of 587 Helicobacter pylori infected subjects were randomised to receive a one week course of anti-Helicobacter therapy (omeprazole, amoxicillin, and clarithromycin (OAC)) or placebo. Subjects underwent endoscopy with biopsy at baseline and at five years. Severity of IM was graded according to the updated Sydney classification and progression was defined as worsening of IM scores at five years in either the antrum or corpus, or development of neoplasia. Backward stepwise multiple logistic regression was used to identify independent risk factors associated with IM progression.
Of 435 subjects (220 in the OAC and 215 in the placebo group) available for analysis, 10 developed gastric cancer and three had dysplasia. Overall progression of IM was noted in 52.9% of subjects. Univariate analysis showed that persistent H pylori infection, age >45 years, male subjects, alcohol use, and drinking water from a well were significantly associated with IM progression. Duodenal ulcer and OAC treatment were associated with a reduced risk of histological progression. Progression of IM was more frequent in those with more extensive and more severe IM at baseline. With multiple logistic regression, duodenal ulcer (odds ratio (OR) 0.23 (95% confidence interval (CI) 0.09-0.58)) was found to be an independent protective factor against IM progression. Conversely, persistent H pylori infection (OR 2.13 (95% CI 1.41-3.24)), age >45 years (OR 1.92 (95% CI 1.18-3.11)), alcohol use (OR 1.67 (95% CI 1.07-2.62)), and drinking water from a well (OR 1.74 (95% CI 1.13-2.67)) were independent risk factors associated with IM progression.
Eradication of H pylori is protective against progression of premalignant gastric lesions.

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    • "Overall Wong et al, 2004 (7) Fukase et al, 2008 (6) Subtotal Leung et al, 2004 (3) Correa et al, 2000 (1) Subtotal Wong et al, 2012 (9) "
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    • "mucins' profiling) and the IMextent (colonic-type metaplasia prevails significantly in extensive intestinalization), leading to the assumption that the topographical extent of IM per se is a reliable indicator of GC risk (given an appropriate endoscopic biopsy mapping) [20] [21]. Since gastric intestinalization is easy to assess histologically , the IM-extent can be assumed as a (clinically) useful marker of gastric cancer risk [20] [21] [22]. "
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    • "premise that eradication of H. pylori infection is an appropriate target for the prevention of gastric cancer is still uncertain. Tree randomized, placebo-controlled trials performed in China and Columbia demonstrated no significant protective effect by H. pylori eradication [16] [17] [18], whereas contradictory results have emerged out of three Japanese studies published recently [19] [20] [21], indicating that H. pylori eradication may prevent the development of gastric cancer significantly, even in patients with precancerous gastric lesions. These reciprocal results can be explained by the fact that, unlike the studies from China and Columbia, protective studies from Japan were neither randomized nor placebo-controlled. "
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