Journal of Digestive Cancer Reports

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
권호 표지

Helicobacter pylori Eradication and Risks of Metachronous Recurrence after Endoscopic Resection of Gastric Adenoma: A Systematic Review and Meta-Analysis

위선종의 내시경 절제 후 이시성 재발의 예방을 위한 헬리코박터 제균 치료: 체계적 문헌분석 및 메타분석

  • Kim, Jie-Hyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Nam, Su Youn (Department of Gastroenterology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Chun, Jaeyoung (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Youn, Young Hoon (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Hyojin (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 김지현 (연세대학교 의과대학 내과학교실, 강남세브란스병원 소화기내과) ;
  • 남수연 (경북대학교 의과대학 내과학교실, 경북대학교병원 소화기내과) ;
  • 천재영 (연세대학교 의과대학 내과학교실, 강남세브란스병원 소화기내과) ;
  • 윤영훈 (연세대학교 의과대학 내과학교실, 강남세브란스병원 소화기내과) ;
  • 박효진 (연세대학교 의과대학 내과학교실, 강남세브란스병원 소화기내과)
  • Received : 2020.11.03
  • Accepted : 2020.11.10
  • Published : 2020.12.31

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Abstract

The effect of Helicobacter pylori (H. pylori) eradication on the development of metachronous recurrence after endoscopic resection (ER) of gastric adenoma is not well defined. The aim of this study was to assess the efficacy of H. pylori eradication after ER of gastric adenoma for the prevention of metachronous recurrence. A systematic literature review and meta-analysis were conducted using the databases Ovid-MEDLINE, EMBASE, Cochrane Library, KoreaMed, and KMBASE. Thus, a systematic review and meta-analysis was performed to investigate this relationship. Pooled risk ratio for metachronous gastric lesions with regard to H. pylori eradication was calculated, and heterogeneity was also measured. Five eligible studies were finally identified in systematic review, and included in meta-analysis. H. pylori eradication was associated with overall 55% lower odds of metachronous events (RR=0.55; 95 % CI 0.34-0.92). Based on the best available evidence, eradication of H. pylori can also provide protection against metachronous recurrence after ER of gastric adenoma.

헬리코박터 파일로리 박멸이 위선종의 내시경 절제술 후 이시성 재발 발생에 미치는 영향은 잘 정의되어 있지 않다. 본 연구의 목적은 위선종의 내시경 절제술 후 헬리코박터 박멸이 이시성 재발 예방에 미치는 효능을 평가하는 것이다. Ovid-MEDLINE, EMBASE, Cochrane Library, KoreaMed 및 KMBASE 데이터베이스를 사용하여 체계적인 문헌 검토 및 메타분석이 수행되었다. 헬리코박터 박멸에 따른 이시성 위병변에 대한 통합 위험비(Pooled risk ratio)를 계산하고 이질성도 측정하였다. 5개의 적격한 연구가 최종적으로 체계적인 검토에서 확인되어 메타분석에 포함되었다. 헬리코박터 박멸은 전체적으로 이시성 재발을 55% 낮출 수 있었다(RR=0.55; 95 % CI 0.34-0.92). 체계적인 문헌 검토 및 메타분석 결과를 바탕으로 헬리코박터 박멸은 위선종의 내시경 절제술 후 이시성 재발 예방에 효과적임을 알 수 있다.

Keywords

References

  1. Song JH, Yang SY, Lim JH, et al. The effect of Helicobacter pylori eradication on the metachronous neoplasm after endoscopic resection for gastric dysplasia. Korean J Gastroenterol 2017;70:27-32. https://doi.org/10.4166/kjg.2017.70.1.27
  2. Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 2004;291:187-194. https://doi.org/10.1001/jama.291.2.187
  3. Wu CY, Kuo KN, Wu MS, et al. Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease. Gastroenterology 2009;137:1641-8 e1-2. https://doi.org/10.1053/j.gastro.2009.07.060
  4. Chen HN, Wang Z, Li X, et al. Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia: evidence from a meta-analysis. Gastric Cancer 2016;19:166-175. https://doi.org/10.1007/s10120-015-0462-7
  5. Fukase K, Kato M, Kikuchi S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008;372:392-397. https://doi.org/10.1016/S0140-6736(08)61159-9
  6. Choi JM, Kim SG, Choi J, et al. Effects of Helicobacter pylori eradication for metachronous gastric cancer prevention: a randomized controlled trial. Gastrointest Endosc 2018;88:475-485 e2. https://doi.org/10.1016/j.gie.2018.05.009
  7. Choi IJ, Kook MC, Kim YI, et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N Engl J Med 2018;378:1085-1095. https://doi.org/10.1056/NEJMoa1708423
  8. Higgins JP, Altman DG, Gotzsche PC, et al. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. https://doi.org/10.1136/bmj.d5928
  9. Kim SY, Park JE, Lee YJ, et al. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 2013;66:408-414. https://doi.org/10.1016/j.jclinepi.2012.09.016
  10. Shin SH, Jung DH, Kim JH, et al. Helicobacter pylori eradication prevents metachronous gastric neoplasms after endoscopic resection of gastric dysplasia. PLoS One 2015;10:e0143257. https://doi.org/10.1371/journal.pone.0143257
  11. Chon I, Choi C, Shin CM, et al. Effect of Helicobacter pylori eradication on subsequent dysplasia development after endoscopic resection of gastric dysplasia. Korean J Gastroenterol 2013;61:307-312. https://doi.org/10.4166/kjg.2013.61.6.307
  12. Take S, Mizuno M, Ishiki K, et al. The effect of eradicating helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol 2005;100:1037-1042. https://doi.org/10.1111/j.1572-0241.2005.41384.x
  13. Takenaka R, Okada H, Kato J, et al. Helicobacter pylori eradication reduced the incidence of gastric cancer, especially of the intestinal type. Aliment Pharmacol Ther 2007;25:805-812. https://doi.org/10.1111/j.1365-2036.2007.03268.x
  14. Kwon YH, Heo J, Lee HS, et al. Failure of Helicobacter pylori eradication and age are independent risk factors for recurrent neoplasia after endoscopic resection of early gastric cancer in 283 patients. Aliment Pharmacol Ther 2014;39:609-618. https://doi.org/10.1111/apt.12633
  15. Hanaoka N, Uedo N, Shiotani A, et al. Autofluorescence imaging for predicting development of metachronous gastric cancer after Helicobacter pylori eradication. J Gastroenterol Hepatol 2010;25:1844-1849. https://doi.org/10.1111/j.1440-1746.2010.06442.x
  16. Correa P. A human model of gastric carcinogenesis. Cancer Res 1988;48:3554-3560.
  17. Jung DH, Kim JH, Lee YC, et al. Helicobacter pylori eradication reduces the metachronous recurrence of gastric neoplasms by attenuating the precancerous process. J Gastric Cancer 2015;15:246-255. https://doi.org/10.5230/jgc.2015.15.4.246
  18. Shiotani A, Uedo N, Iishi H, et al. Re-expression of sonic hedgehog and reduction of CDX2 after Helicobacter pylori eradication prior to incomplete intestinal metaplasia. Int J Cancer 2007;121:1182-1189. https://doi.org/10.1002/ijc.22835
  19. van den Brink GR, Hardwick JC, Nielsen C, et al. Sonic hedgehog expression correlates with fundic gland differentiation in the adult gastrointestinal tract. Gut 2002;51:628-633. https://doi.org/10.1136/gut.51.5.628
  20. Shiotani A, Iishi H, Uedo N, et al. Evidence that loss of sonic hedgehog is an indicator of Helicobater pylori-induced atrophic gastritis progressing to gastric cancer. Am J Gastroenterol 2005;100:581-587. https://doi.org/10.1111/j.1572-0241.2005.41001.x
  21. Mizoshita T, Inada K, Tsukamoto T, et al. Expression of CDX1 and CDX2 mRNAs and relevance of this expression to differentiation in human gastrointestinal mucosa--with special emphasis on participation in intestinal metaplasia of the human stomach. Gastric Cancer 2001;4:185-191. https://doi.org/10.1007/PL00011741
  22. Tsukamoto T, Inada K, Tanaka H, et al. Down-regulation of a gastric transcription factor, SOX2, and ectopic expression of intestinal homeobox genes, CDX1 and CDX2: inverse correlation during progression from gastric/intestinal-mixed to complete intestinal metaplasia. J Cancer Res Clin Oncol 2004;130:135-145. https://doi.org/10.1007/s00432-003-0519-6