CROATIAN GUIDELINES FOR GASTRIC CANCER PREVENTION BY ERADICATION OF HELICOBACTER PYLORI INFECTION
Autori:
Miroslava Katičić, Marko Banić, Marija Crnčević Urek, Slavko Gašparov, Željko Krznarić, Marija Prskalo, Davor Štimac, Anita Škrtić, Boris Vucelić
Sažetak
Želučani je rak četvrti po učestalosti karcinom u svijetu i drugi po učestalosti uzrok mortaliteta izazvanog malignim bolestima. Iako je etiologija tog karcinoma multifaktorska, infekcija Helicobacterom pyloriizrazito je povezana sa želučanom karcinogenezom. Na karcinogenezu utječu i neki čimbenici okoliša, kao i genska raznolikost, koji mogu dovesti do različitih upalnih odgovora te time utjecati na klinički ishod bolesti. Kronični gastritis izazvan infekcijom Helicobacterom pylori najjači je poznati čimbenik rizika od razvoja adenokarcinoma distalnog dijela želuca premda učinak bakterijske eradikacije na samu karcinogenezu ostaje zasad nedovoljno istražen. Iako se čini da eradikacija infekcije Helicobacterom pylori smanjuje rizik od nastanka želučanog karcinoma, više novijih terapijskih pokušaja prevencije nastanka tog tumora eradikacijom infekcijeHelicobacterom pylori postiglo je razočaravajuće rezultate. U pokušaju razjašnjenja tog problema u populacijama s visokim rizikom istraživači su započeli provoditi prospektivne randomizirane, dvostruko slijepe populacijske studije. Rezultati prethodnih studija upozorili su na važnost dugotrajnog i pomnog praćenja bolesnika nakon provedene eradikacijske terapije. Čini se da je eradikacija infekcije u svrhu prevencije želučanog karcinoma djelotvorna samo onda kada se provede prije razvoja premalignih promjena/lezija: atrofije, metaplazije i displazije želučane sluznice. Osim toga, značajna učinkovitost izlječenja uočena u mlađih bolesnika sugerira potrebu provođenja eradikacije infekcije Helicobacterom pylori što je moguće ranije.
Summary
Gastric cancer is the fourth most common type of cancer and the second leading cause of cancer-related death in the world. Although gastric cancer has a multifactorial etiology, infection with Helicobacter pyloriis highly associated with gastric carcinogenesis. Carcinogenesis is also influenced by some environmental factors and host genetic diversity, which engenders differential host inflammatory responses that can influence clinical outcome. Chronic gastritis induced by H. pylori is the strongest known risk factor for adenocarcinoma of the distal stomach, but the effects of bacterial eradication on carcinogenesis have remained unclear up to now. Although eradication of H. pylori infection appears to reduce the risk of gastric cancer, several recent controlled interventional trials by H. pylori eradication to prevent gastric cancer have yielded disappointing results. To clarify this problem in a high-risk population, the investigators conducted a prospective, randomized, double-blind, placebo-controlled, population-based studies. The results of previous studies highlight the importance of longer and careful follow-up after eradication therapy. It seems that eradication treatment is effective in preventing gastric cancer if it is given before preneoplastic conditions/lesions, gastric atrophy, metaplasia, and dysplasia, have had time to develop. Furthermore, the significant efficacy of treatment observed in younger patients suggests the need to eradicate H. pylori as early as possible. This consensus aimed to propose guidelines for the diagnosis, management and control of individuals with chronic gastritis, atrophy, intestinal metaplasia, or dysplasia.
