Gastric cancer in a patient with chronic gastritis after H. pylori eradication: assessing the risks

Stomach cancer occupies a leading position in oncological morbidity and mortality worldwide. Approximately 800,000 people die from stomach cancer every year. In two-thirds of patients gastric cancer is diagnosed at a late stage, when radical treatment becomes impossible. Helicobacter pylori (H. pylori) infection is considered as the main etiological factor for gastric cancer. To stratify the risk of developing gastric cancer an assessment of morphological changes in the gastric mucosa using the Operative Link for Gastritis Assessment of Atrophic Gastritis (OLGA) system is used. The stage of gastritis plays a key role in determining an individual’s risk of developing stomach cancer. H. pylori eradication therapy is an effective method for preventing gastric cancer. However not in all patients the elimination of the infection can prevent the development of gastric cancer in the future. It is extremely important to identify a group of people with ex-helicobacter gastritis, who have a high risk of developing stomach cancer, and to take timely preventive measures in them. The purpose of this publication is to summarize and systematize the currently available data on the risk of developing gastric cancer in patients with H. pylori-associated gastritis, including those after successful eradication.

gastric cancer, chronic gastritis, H. pylori, eradication therapy, atrophy of the gastric mucosa, intestinal metaplasia, carcinoprevention, cytoprotectors

1. WHO: International Agency for Research on Cancer. Stomach. 2020. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf (Accessed: 23 March 2022).

2. Bray F., Ferlay J., Soerjomataram I., et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018;68(6): 394-424. doi: 10.3322/caac.21492

3. Cheung K. S., Leung W. K. Risk of gastric cancer development after eradication of Helicobacter pylori. World journal of gastrointestinal oncology. 2018;10(5): 115-123. doi:10.4251/wjgo.v10.i5.115

4. Livzan M. A., Kononov A. V., Mozgovoy S. I. Ex-helicobacter gastritis: neologism or clinical reality? Experimental and clinical gastroenterology. 2004;(5): 115-123. (In Russ.) @@Ливзан М. А., Кононов А. В., Мозговой С. И. Экс-хеликобактерный гастрит: неологизм или клиническая реальность? Экспериментальная и клиническая гастроэнтерология. 2004;(5): 115-123.

5. Topi S., Santacroce L., Bottalico L., et al. Gastric Cancer in History: A Perspective Interdisciplinary Study. Cancers (Basel). 2020;12(2): 264. doi:10.3390/cancers12020264

6. Bordin D. S., Yanova O. B., Abdulkhakov R. A., et al. European Registry on the management of Helicobacter pylori infection (Hp-EuReg protocol): The first results of Russian centers. Terapevticheskii arkhiv. 2016;88(2): 33-38. (In Russ.) doi:10.17116/terarkh201688233-38 @@Бордин Д. С., Янова О. Б., Абдулхаков Р. А. Европейский регистр Helicobacter pylori (протокол Hp-EuReg): первые результаты Российских центров. Терапевтический архив. 2016;88(2): 33-38. doi:10.17116/terarkh201688233-38

7. Bordin D.S., Embutnieks Yu.V., Vologzhanina L. G. European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia. Terapevticheskii arkhiv. 2018;90(2): 35-42 (In Russ.) doi:10.26442/00403660.2019.02.000156 @@Бордин Д. С., Эмбутниекс Ю. В., Вологжанина Л. Г. Европейский регистр Helicobacter pylori (HP-EUREG): Анализ данных 2360 больных, получавших терапию первой линии в России. Терапевтический архив. 2018;90(2): 35-42. doi:10.26442/00403660.2019.02.000156

8. Raza Y., Ahmed A., Khan A., et al. Helicobacter pylori severely reduces expression of DNA repair proteins PMS2 and ERCC1 in gastritis and gastric cancer. DNA Repair (Amst). 2020;89: 102836. doi:10.1016/j.dnarep.2020.102836

9. Kumar S., Metz D. C., Ellenberg S., et al. Risk Factors and Incidence of Gastric Cancer After Detection of Helicobacter pylori Infection: A Large Cohort Study. Gastroenterology. 2020;158(3): 527-536.e7. doi:10.1053/j.gastro.2019.10.019

10. de Brito B. B., da Silva F. A.F., Soares A. S. et al. Pathogenesis and clinical management of Helicobacter pylori gastric infection. World journal of gastroenterology. 2019;25(37): 5578-5589. doi:10.3748/wjg.v25.i37.5578

11. Correa P., Haenszel W., Cuello C., et al. A model for gastric cancer epidemiology. Lancet. 1975;2(7924): 58-60. doi:10.1016/s0140-6736(75)90498-5

12. Uno Y. Prevention of gastric cancer by Helicobacter pylori eradication: A review from Japan. Cancer medicine. 2019;8(8): 3992-4000. doi:10.1002/cam4.2277

13. Gu H. Role of Flagella in the Pathogenesis of Helicobacter pylori. Current microbiology. 2017;74(7): 863-869. doi:10.1007/s00284-017-1256-4

14. Waskito L. A., Salama N. R., Yamaoka Y. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2018;23 Suppl: e12516. doi:10.1111/hel.12516

15. Chmiela M., Kupcinskas J. Review: Pathogenesis of Helicobacter pylori infection. Helicobacter. 2019;24 Suppl 1(Suppl Suppl 1): e12638. doi:10.1111/hel.12638

16. Camilo V., Sugiyama T., Touati E. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2017;22 Suppl 1: 10.1111/hel.12405. doi:10.1111/hel.12405

17. Sierra D., Wood M., Kolli S., Felipez L. M. Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease. Pediatrics in review. 2018;39(11): 542-549. doi:10.1542/pir.2017-0234

18. Bacha D., Walha M., Ben Slama S., et al. Chronic gastritis classifications. Tunisie medicale. 2018;96(7): 405-410.

19. Shah S. C., Gawron A. J., Mustafa R. A., Piazuelo M. B. Histologic Subtyping of Gastric Intestinal Metaplasia: Overview and Considerations for Clinical Practice. Gastroenterology. 2020;158(3): 745-750. doi:10.1053/j.gastro.2019.12.004

20. Bockerstett K. A., Lewis S. A., Noto C. N., et al. Single-Cell Transcriptional Analyses Identify Lineage-Specific Epithelial Responses to Inflammation and Metaplastic Development in the Gastric Corpus. Gastroenterology. 2020;159(6): 2116-2129.e4. doi:10.1053/j.gastro.2020.08.027

21. Goldenring J. R., Mills J. C. Cellular Plasticity, Reprogramming, and Regeneration: Metaplasia in the Stomach and Beyond. Gastroenterology. 2022;162(2): 415-430. doi:10.1053/j.gastro.2021.10.036

22. den Hoed C. M., Kuipers E. J. Gastric Cancer: How Can We Reduce the Incidence of this Disease? Current gastroenterology reports. 2016;18(7): 34. doi:10.1007/s11894-016-0506-0

23. Livzan M. A., Kostenko M. B. Peptic ulcer disease: modern approaches to diagnosis and therapy. Lechaschi Vrach. 2010;(7): 20. (In Russ.) @@Ливзан М. А., Костенко М. Б. Язвенная болезнь: современные подходы к диагностике и терапии. Лечащий врач. 2010;(7): 20.

24. Tsuda M., Asaka M., Kato M., et al. Effect on Helicobacter pylori eradication therapy against gastric cancer in Japan. Helicobacter. 2017;22(5): e12415. doi:10.1111/hel.12415

25. Bordin D. S., Embutnieks Yu.V., Vologzhanina L. G., et al. European helicobacter pylori registry (Hp-EuReg): data analysis of 2,360 patients receiving first-line therapy in Russia. Terapevticheskii arkhiv. 2018;90(2): 35-42 (In.Russ.) doi:10.26442/terarkh201890235-42 @@Бордин Д. С., Эмбутниекс Ю. В., Вологжанина Л. Г. Европейский регистр helicobacter pylori (Hp-EuReg): анализ данных 2360 больных, получавших терапию первой линии в России. Терапевтический архив. 2018;90(2): 35-42. doi:10.26442/terarkh201890235-42

26. Malfertheiner P., Megraud F., O’Morain C.A., et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017;66(1): 6-30. doi:10.1136/gutjnl-2016-312288

27. Ford A. C., Forman D., Hunt R. H., et al. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical research ed.) 2014;348: g3174. doi:10.1136/bmj.g3174

28. Tan M. C., Graham D. Y. Gastric cancer risk stratification and surveillance after Helicobacter pylori eradication: 2020. Gastrointestinal endoscopy. 2019;90(3): 457-460. doi:10.1016/j.gie.2019.05.034

29. Livzan M. A., Mozgovoy S. I., Kononov A. V. Gastritis after eradication of Helicobacter pylori - simple traces or serious consequences? Lechaschi Vrach. 2011;(7): 7 (In Russ.) @@Ливзан М. А., Мозговой С. И., Кононов А. В. Гастрит после эрадикации Helicobacter pylori - простые следы или серьезные последствия? Лечащий Врач. 2011;(7):7.

30. Livzan M. A. Underwater rocks of anti-helicobacter therapy. Therapeutic Archive. 2019;91(8): 141-147 (In Russ.) doi:10.26442/00403660.2019.08.000386 @@Ливзан М. А. Подводные камни антихеликобактерной терапии. Терапевтический архив. 2019;91(8): 141-147. doi:10.26442/00403660.2019.08.000386

31. Shibata W., Sue S., Tsumura S., et al. Helicobacter-induced gastric inflammation alters the properties of gastric tissue stem/progenitor cells. BMC Gastroenterol. 2018;18(1): 4. doi:10.1186/s12876-017-0706-6

32. Hwang Y. J., Kim N., Lee H. S., et al. Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication - a prospective study for up to 10 years. Alimentary pharmacology & therapeutics. 2018;47(3): 380-390. doi:10.1111/apt.14424

33. Alekseyenko S. A., Bagdasaryan A. A., Bakulin I. G., et al. Brief algorithms for managing patients at the stage of primary health care. Moscow. Vidoks Publ, 2019. (in Russ.) @@Алексеенко С. А., Багдасарян А. А., Бакулин И. Г., и др. Краткие алгоритмы ведения пациентов на этапе оказания первичной медико- санитарной помощи. Москва: Видокс, 2019.

34. Ivashkin V. T., Mayev I. V., Kaprin A. D., et al. Early Detection of Oncological Diseases of the Digestive System (Guidelines of the Russian Gastroenterological Association and the Russian Association of Oncologists for Primary Care Physicians).Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019;29(5): 53-74 (In Russ.). doi:10.22416/1382-4376-2019-29-5-53-74 @@Ивашкин В. Т., Маев И. В., Каприн А. Д. и др. Раннее выявление онкологических заболеваний органов пищеварения (методическое руководство Российской гастроэнтерологической ассоциации и Ассоциации онкологов России для врачей первичного звена здравоохранения). Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2019;29(5): 53-74. doi:10.22416/1382-4376-2019-29-5-53-74