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Risk of gastric cancer in the second decade of follow-up after Helicobacter pylori eradication

  • Take, Susumu1, 2
  • Mizuno, Motowo3
  • Ishiki, Kuniharu2
  • Kusumoto, Chiaki2
  • Imada, Takayuki2
  • Hamada, Fumihiro2
  • Yoshida, Tomowo2
  • Yokota, Kenji4
  • Mitsuhashi, Toshiharu5
  • Okada, Hiroyuki4
  • 1 Fukuwatari Municipal Hospital, 1000 Fukuwatari, Takebe-cho, Kitaku, Okayama, 709-3111, Japan , Okayama (Japan)
  • 2 Nippon Kokan Fukuyama Hospital, 1840 Tsunoshita, Daimon-cho, Fukuyama, 721-0927, Japan , Fukuyama (Japan)
  • 3 Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan , Okayama (Japan)
  • 4 Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan , Okayama (Japan)
  • 5 Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan , Okayama (Japan)
Published Article
Journal of Gastroenterology
Springer Singapore
Publication Date
Oct 30, 2019
DOI: 10.1007/s00535-019-01639-w
Springer Nature


Background and aimsEradication of Helicobacter pylori reduces the risk of gastric cancer. In this study, we investigated the risk beyond 10 years after eradication of H. pylori.MethodsWe conducted a retrospective cohort study of 2737 patients who had yearly endoscopic follow-up after cure of H. pylori infection. For comparison of gastric cancer risk in the second decade of follow-up with that in the first decade, we calculated standardized incidence ratios (SIRs) by dividing the number of observed cases of gastric cancer in the second decade of follow-up by that of expected cases which was estimated using the incidence rate ratio of age in the first decade.ResultsDuring the follow-up for as long as 21.4 years (mean 7.1 years), gastric cancer developed in 68 patients (0.35% per year). The SIRs for diffuse-type gastric cancer was infinity (0 expected case and 4 observed cases) in patients with mild gastric mucosal atrophy and 10.9 (95% confidence interval 4.53–26.1) with moderate atrophy, whereas no significant increase of SIRs was observed in intestinal-type cancer regardless of the grade of baseline gastric atrophy or in diffuse-type cancer in patients with severe atrophy even though who had the highest risk.ConclusionsThe longer the follow-up, the greater the risk of developing diffuse-type gastric cancer becomes in patients with mild-to-moderate gastric atrophy at baseline. Endoscopic surveillance should be continued beyond 10 years after cure of H. pylori irrespective of the severity of gastric atrophy.

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