Characteristics Associated With Spontaneous Helicobacter pylori Clearance After Subtotal Gastrectomy in Patients With Gastric Cancer.

Abstract

Objective: Helicobacter pylori eradication treatment typically occurs after gastrectomy; however, the specific criteria for eradication treatment have not been reported. This study aimed to evaluate the rates and locations of spontaneous clearance, as well as the accompanying histological changes.

Methods: Patients with H. pylori-positive status at the time of gastric cancer diagnosis and who underwent subtotal gastrectomy at a tertiary care center in Seoul (South Korea) were prospectively enrolled in this study. H. pylori infection status and histological features (presence of mononuclear cells, neutrophils, atrophy, and intestinal metaplasia) were evaluated pre- and postoperatively at different locations in the stomach.

Results: Sixteen patients with H. pylori-positive gastric cancer underwent subtotal gastrectomy. Of these, 13 (81.3%) showed spontaneous clearance at least once during the follow-up. Half of the patients (8, 50.0%) had cleared their infections within 6 months after surgery. Histological factors, such as neutrophil and mononuclear cell counts, atrophy, and intestinal metaplasia, did not differ according to H. pylori clearance status. The spontaneous clearance rates of H. pylori were 69.2% in the cardia, 46.1% in the fundus, 38.4% in the lesser curvature of the mid-body, and 41.6% in the greater curvature of the mid-body; the differences in clearance rates were not significant (p=0.149).

Conclusions: The rate of spontaneous H. pylori clearance was high in patients with gastric cancer who underwent subtotal gastrectomy. Postoperative H. pylori status should be re-evaluated to confirm the presence of infection prior to considering eradicating therapy.