Helicobacter pylori eradication reduces risk for recurrence of gastric hyperplastic polyp after endoscopic resection
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Gastric hyperplastic polyps are the most common type of polypoid lesion of the stomach. These are inflammatory proliferations of gastric foveolar cells due to chronic inflammation caused by Helicobacter pylori (H. pylori) infection [1]. It has been known that eradication of H. pylori could lead to the disappearance or regression of gastric hyperplastic polyps [2]. In Japan and China studies, they reported that the rate of disappearance of gastric hyperplastric polyps after H. pylori eradication was 68–85% [2-6]. Also, Japanese and British guidelines recommend H. pylori eradication as first treatment in patients with gastric hyperplastic polyps [7,8].
Until now, there is limited data on the efficacy of H. pylori eradication for gastric hyperplastic polyps in Korea. Previously, H. pylori eradication might be an effective therapeutic option for gastric hyperplastic polyps, and especially for those that are less than 10 mm in size (42.5% vs. 22.2%, p < 0.05) [9,10]. In National Cancer Screening Cohort, successful eradication of H. pylori infection may induce disappearance of gastric hyperplastic polyps (85.0% vs. 29.0%, p < 0.01), although only patients with H. pylori eradication therapy were targeted [11]. In prospective study that enrolled 25 H. pylori-positive patients diagnosed as having gastric hyperplastic polyps, H. pylori eradication (odds ratio, 40.047; 95% confidence interval, 1.112–1442.767; p = 0.04) and female sex were significant predictive factors of polyp regression [12]. The domestic clinical studies conducted so far are summarized in the Table 1 [9-14]. However, there are several limitations, and most of studies are relatively small size. Second, we have to consider that small portion of gastric hyperplastic polyps can turn into gastric cancer. Third, H. pylori eradication treatment does not eliminate all cases of gastric hyperplastic polyps, and there are no studies on recurrence of gastric hyperplastic polyps after H. pylori eradication. Long-term follow-up is required for the disappearance and recurrence of polyps.
Clinical trials of Helicobacter pylori eradication therapy for gastric hyperplastic polyps conducted in Korea
In this study, authors focused on the effect of H. pylori eradication on the recurrence of gastric hyperplastic polyps after endoscopic resection [15]. Most artificial ulcers caused by endoscopic submucosal resection (EMR) or dissection healed similarly to benign gastric ulcer scars, but in several cases, they would take the form of protruded lesions. According to a previous report, protruded lesions occurred in about 18.8% of EMR scars, and intestinal metaplasia/regenerative hyperplasia were shown in histological examination [16]. All of them were benign lesions unrelated to the recurrence of primary lesions. In the period when there is not much experience of EMR, it was natural to suspect recurrence by looking at the protruded lesions after the procedure. However, most were turned out to be benign lesions, and histologic findings were very similar to those of gastric hyperplastic polyps. In this study, recurrent gastric polyps developed after EMR in 19.2% of the non-eradication group and 8.1% of the eradication group during the mean follow-up period of 18.3 months. Successful eradication of H. pylori may reduce the recurrence of gastric hyperplastic polyps in patients after EMR.
In the near future, large-scale multicenter studies organized by academic societies or national institutions would be expected on the efficacy of H. pylori eradication for gastric hyperplastic polyps. We hope to include the patients with H. pylori-positive gastric hyperplastic polyps in the Korean H. pylori treatment guidelines, and insurance reimbursement criteria.
Notes
No potential conflict of interest relevant to this article was reported.