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Kim, Yang, Min, Lee, Rhee, Rhee, and Kim: Helicobacter pylori Eradication for Stage I E1 Gastric Mucosa-associated Lymphoid Tissue Lymphoma: Predictive Factors of Complete Remission
Original Article

Korean J Gastroenterol 2010;55(2):94-99.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.2.94

Helicobacter pylori Eradication for Stage I E1 Gastric Mucosa-associated Lymphoid Tissue Lymphoma: Predictive Factors of Complete Remission

Su Jin Kim, M.D., Sun Yang, M.D., Byung-Hoon Min, M.D., Jun Haeng Lee, M.D., Poong-Lyul Rhee, M.D., Jong Chul Rhee, M.D., Jae J. Kim, M.D.

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Jae J. Kim, M.D. Department of Medicine, Samsung Medical Center, 50, Irwon- dong, Gangnam-gu, Seoul 135-710, Korea Tel: +82-2-3410-3409, Fax: +82-2-3410-6983 E-mail: jjkim@skku.edu

Received 2 June 2009       Accepted 28 December 2009

Copyright © 2010 The Korean Journal of Gastroenterology

Abstract

Background/Aims

Eradication of Helicobacter pylori (H. pylori) is accepted as initial treatment of stage I E1 gastric mucosa associated lymphoid tissue (MALT) lymphoma. However, 10-20% of gastric low grade MALT lymphomas are unresponsive to H. pylori eradication treatment. The aim of this study was to find out the predictive factors of complete remission of gastric MALT lymphoma after H. pylori eradication.

Methods

From 1995 to 2006, consecutive 95 patients with modified Ann Arbor stage I E1 gastric MALT lymphoma were enrolled, and their medical records were reviewed. The patients were initially treated by H. pylori eradication. The complete remission was determined by endoscopic and histologic finding.

Results

Eighty eight patients (92.6%) achieved complete remission after H. pylori eradication therapy. Mean follow up time for these patients was 40±25 months. Seven patients (7.4%) failed to achieve complete remission. There was no significant difference in the age, sex, endoscopic appearance, and large cell component between the remission group and failure group. Among 66 patients with distal tumor, 65 patients (98.5%) achieved complete remission. On the other hand, among 13 patient with proximal tumor, 9 patients (69.2%) achieved complete remission (p=0.001). The odds ratio of proximal tumor for H. pylori eradication failure was 28.9 (95% CI=2.9-288.0).

Conclusions

The proximally location of MALT lymphoma is a risk factor of the H. pylori eradication treatment failure. Therefore, the proximally located gastric MALT lymphoma should be carefully treated and followed.

Keywords: MALT lymphoma, H. pylori, Location, Therapy

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Fig. 1.
Different treatment response to H. pylori eradication according to site. (A, B) A case of gastric MALT lymphoma located on the distal part of stomach showing complete response 3 months after H. pylori eradication (A: before treatment, B: after treatment). (C, D) A case of gastric MALT lymphoma located on the proximal part of stomach showing no improvement during follow-up of 9 months after H. pylori eradication (C: before treatment, D: after treatment).
kjg-55-94f1.tif
Table 1.
Baseline Characteristics and Risk Factor Analysis of Failure of MALT-lymphoma Remission
Remission (n=88) Failure (n=7) p-value
Age, mean (range), years 50±12 48±9 0.465
Sex (M:F) (%) 48:40 (55:45) 3:4 (43:57) 0.083
Follow up duration, (mean± SD, month) 40±25 35±15 0.513
Endoscopic location (%) 0.001
Distal 65 (73.9%) 1 (14.3%)
Both 14 (15.9%) 2 (28.6%)
Proximal 9 (10.2%) 4 (57.1%)
Endoscopic appearance (%) 0.344
Ulcer 33 (37.5%) 4 (57.1%)
Erosion 20 (22.7%) 2 (28.6%)
Erythema 29 (33.0%) 0 (0%)
Thick folds or tumor 6 (6.8%) 1 (14.3%)
Presence of large cell component (＋) (%) 1 (1.1%) 1 (14.3%) 0.067

SD, standard deviation.

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