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Kichul Yoon1, 2, Nayoung Kim1, 3
Abstract
Although there are many guidelines recommending Helicobacter pylori (H. pylori) eradication therapy for atrophic gastritis (AG) and intestinal metaplasia (IM), there have been contradictory reports regarding the reversibility of precancerous lesions such as AG and IM after eradication of H. pylori. There have been many reports that have shown AG seems to improve upon eradication of H. pylori to some extent. In contrast, IM has been regarded as ‘the point of no return’ according to previous reports. However, as recent studies have suggested the improvement of intestinal metaplasia as well, early eradication therapy for reversible histological status is important and necessary for the prevention of gastric cancer. In this review, we focused on the progress of gastritis resulting in AG and IM mainly by H. pylori, the relationship of AG and IM with gastric cancer, the subtype of IM, and the reversibility of AG and IM by eradication of H. pylori. Finally, we introduced the recent extension of indications for H. pylori eradication with coverage by medical insurance, which was published by the Korean Ministry of Health and Welfare in January 2018.
Figures and Tables
Fig. 1
Classification of gastritis (H&E,×400). (A) Normal, (B) superficial gastritis, (C) atrophic gastritis, and (D) intestinal metaplasia. Upper panel is endoscopic, and lower panel is histologic finding. Adapted from Park and Kim56, with permission from J Cancer Prev.
Fig. 2
The optimal gastric biopsy sites recommended by the updated Sydney system. Biopsy specimens are taken at five different sites. (A) Lesser curvature of the antrum. (B) Greater curvature of the antrum. (C) Lesser curvature of the corpus. (D) Greater curvature of the corpus. (E) Incisura angularis.
Table 1
Key Studies on Improvement of Atrophic Gastritis and Intestinal Metaplasia after Eradication Therapy89
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