Review
Effects of Helicobacter pylori Eradication on Early Stage Gastric Mucosa–Associated Lymphoid Tissue Lymphoma

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Background & Aims

Different remission rates of gastric low-grade, B-cell, mucosa–associated lymphoid tissue (MALT) lymphoma have been reported after Helicobacter pylori eradication. We assessed the long-term remission and relapse rates of early stage MALT lymphoma in patients treated only by H pylori eradication and identified factors that might predict outcome.

Methods

This systematic review analyzed data from 32 studies, including 1408 patients.

Results

The MALT lymphoma remission rate was 77.5% (95% confidence interval, 75.3−79.7), and was significantly higher in patients with stage I than stage II1 lymphoma (78.4% vs 55.6%; P = .0003) and in Asian than in Western groups (84.1% vs 73.8%; P = .0001). Neoplasia confined to the submucosa regressed more frequently than that with deeper invasion (82.2% vs 54.5%; P = .0001); patients with lymphoma localized to the distal stomach experienced regression more frequently than those with lymphoma of the proximal stomach (91.8% vs 75.7%; P = .0037). The remission rate was higher among patients without the API2–MALT1 translocation than in those with this translocation (78% vs 22.2%; P = .0001). In an analysis of data from 994 patients, 7.2% experienced lymphoma relapse during 3253 patient-years of follow-up evaluation, with a yearly recurrence rate of 2.2%. Infection and lymphoma were cured by additional eradication therapy in all patients with H pylori recurrence (16.7%). Five (0.05%) of the patients initially cured of lymphoma developed high-grade lymphoma within 6 to 25 months of therapy.

Conclusions

H pylori eradication is effective in treating approximately 75% of patients with early stage gastric lymphoma. Long-term follow-up evaluation of these patients is needed to detect early lymphoma relapse or progression.

Section snippets

Literature Search

Separate computer-assisted searches were performed using PubMed. Each search was performed on all English language articles through June 2008, using the exploded medical subject heading terms lymphoma, Helicobacter pylori, therapy, eradication, remission, and follow up. Boolean operators (NOT, AND, OR) also were used in succession to narrow and widen the search. Only studies concerning primary, low-grade, MALT lymphoma of the stomach associated with H pylori infection were considered; diffuse

Search Results

After a thorough review of the titles, abstracts, and text of the potentially relevant studies, the full text from 79 studies of H pylori eradication in patients with gastric lymphoma was retrieved and evaluated. Of these, 32 trials met inclusion criteria for this pooled analysis13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44; 47 studies were not included (Table 1). The exclusion criteria were as follows: (1)

Discussion

Primary gastric MALT lymphoma is a neoplasia that is associated with H pylori infection. H pylori eradication leads to complete remission of gastric low-grade lymphoma in 35% to 100% of patients, according to different studies.1 A recent systematic review described a high rate of remission (68.8% in 61 cases) in patients with high-grade lymphoma after therapy via only bacterial eradication.45 Current international guidelines suggest bacterial eradication therapy for all patients with MALT

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    Conflicts of interest The authors disclose no conflicts.

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