Helicobacter pylori eradication may cure low-grade gastric lymphoma

Treatment to eradicate Helicobacter pylori may be sufficient on its own to cure low grade gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT), according to a prospective study in which patients were followed for up to 89 months.

H. pylori is believed to play a key role in the development and progression of this disease, Dr. Wolfgang Fischbach, at Klinikum Aschaffenburg in Germany, and his associates note in the January issue of Gut. Although treatment to eliminate the bacterial infection is a common initial therapy, little is known about the long-term outcomes for these patients.The group therefore prospectively followed 90 patients stage I gastric MALT for at least a year after H. pylori eradication treatment with omeprazole, clarithromycin, and metronidazole or amoxicillin for 7 days. Endoscopy and ultrasound were repeated every 3 months for the first 2 years, then semiannually thereafter. Eradication was achieved in 88 patients. The authors observed complete regression of lymphoma in 56 (62%), minimal residual disease in 17, partial remission in 11, no change in four and progressive disease in two patients. Complete regression was observed in four of nine patients with documented stage I2 disease and in 23 of 42 with stage I1 disease.”Considering the possible regression of lymphoma even in locally more advanced stages, we would not at present exclude patients with infiltration of the submucosal or muscularis propria from eradication therapy,” Dr. Fischbach’s group writes. “However, they may need a more intensive follow up.”In four patients with initial remission that relapsed at 6 to 15 months, only in one was H. pylori detected again. Repeat antibiotic treatment was followed by lymphoma regression in this one case.The research team notes that endoscopy and endosonographic findings normalized but lymphoma infiltrates persisted in 17 patients. “After extensive and repeated information from the patients,” they add, these patients did well with a watch and wait strategy.Most patients treated exclusive with H. pylori eradication “have a favourable long term outcome,” the researchers conclude, “offering a real chance of cure.”(Source: Gut 2004;53:34-37: Reuters Health: January 9, 2004: Oncolink)