Zusammenfassung
Das Magenkarzinom ist weiterhin einer der häufigsten Krebsarten in der Welt und mit einer hohen Mortalität vergesellschaftet. Das Nicht-Kardia-Magenkarzinom entwickelt sich typischerweise auf dem Boden einer Kaskade mukosaler Veränderungen beginnend von der nichtatrophischen Gastritis zur atrophischen Gastritis (AG), der intestinalen Metaplasie (IM) zur Dysplasie bis hin zum Adenokarzinom des Magens. Von daher werden die atrophische Gastritis und die intestinale Metaplasie als präneoplastische Bedingungen des Magens angesehen. Die Ätiologie der atrophischen Gastritis ist auf die Helicobacter (H.)-pylori-Infektion und die autoimmune Gastritis beschränkt. Die H.-pylori-Eradikationstherapie bietet die einmalige Chance, das Magenkarzinom und ein Fortschreiten der präneoplastischen Bedingungen zu verhindern. Hierbei sollte die Infektion mit H. pylori zum frühsten möglichen Zeitpunkt ausgeschaltet werden, um die Kaskade hin zum Magenkarzinom noch rechtzeitig abfangen zu können. Bei Patienten mit dem Nachweis einer präneoplastischen Bedingung des Magens sollten endoskopische Überwachungsstrategien des Magens angewendet werden. Diese Arbeit bietet einen Überblick über präneoplastische Bedingungen des Magens, Therapieoptionen und mögliche Überwachungsstrategien.
Abstract
Gastric cancer is one of the most common cancers in the world and is associated with a high mortality. Noncardia gastric cancer usually develops through a cascade of mucosal changes from nonatrophic gastritis to atrophic gastritis, intestinal metaplasia, dysplasia, and adenocarcinoma. Atrophic gastritis and intestinal metaplasia are therefore considered as preneoplastic conditions in the stomach. The etiology of atrophic gastritis is based on Helicobacter pylori infection and/or autoimmune gastritis. H. pylori eradication therapy offers the unique chance to prevent gastric cancer and to improve preneoplastic conditions of the stomach. Eradication therapy should be offered at the earliest stage with the goal to interrupt the cascade leading to gastric cancer. Patients with preneoplastic conditions of the stomach should be monitored using clinically meaningful endoscopic surveillance strategies. This review focuses on preneoplastic conditions of the stomach, therapeutic options, and possible surveillance strategies.
Literatur
Correa P, Piazuelo MB (2012) The gastric precancerous cascade. J Dig Dis 13:2–9. https://doi.org/10.1111/j.1751-2980.2011.00550.x
Dinis-Ribeiro M, Areia M, de Vries AC et al (2012) Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa. Endoscopy 44:74–94. https://doi.org/10.1055/s-0031-1291491
Doorakkers E, Lagergren J, Engstrand L, Brusselaers N (2016) Eradication of Helicobacter pylori and gastric cancer: a systematic review and meta-analysis of cohort studies. J Natl Cancer Inst 108:djw132. https://doi.org/10.1093/jnci/djw132
Fischbach AW, Malfertheiner P, Lynen Jansen P et al (2016) S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit S2k-guideline Helicobacter pylori and gastroduodenal ulcer disease Verantwortlich für die DGVS. Z Gastroenterol 54:327–363. https://doi.org/10.1055/s-0042-102967
Hooi JKY, Lai WY, Ng WK et al (2017) Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. https://doi.org/10.1053/j.gastro.2017.04.022
Hwang Y‑J, Kim N, Lee HS et al (2017) Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication—a prospective study for up to 10 years. Aliment Pharmacol Ther. https://doi.org/10.1111/apt.14424
Isajevs S, Liepniece-Karele I, Janciauskas D et al (2014) Gastritis staging: interobserver agreement by applying OLGA and OLGIM systems. Virchows Arch 464:403–407. https://doi.org/10.1007/s00428-014-1544-3
Kong Y‑J, Yi H‑G, Dai J‑C, Wei M‑X (2014) Histological changes of gastric mucosa after Helicobacter pylori eradication: a systematic review and meta-analysis. World J Gastroenterol 20:5903–5911. https://doi.org/10.3748/wjg.v20.i19.5903
Kuipers EJ (1998) Review article: relationship between Helicobacter pylori, atrophic gastritis and gastric cancer. Aliment Pharmacol Ther 12(Suppl 1):25–36
Kuipers EJ, Uyterlinde AM, Peña AS et al (1995) Long-term sequelae of Helicobacter pylori gastritis. Lancet 345:1525–1528
Lee Y‑C, Chiang T‑H, Chou C‑K et al (2016) Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology 150:1113–1124.e5. https://doi.org/10.1053/j.gastro.2016.01.028
Leung WK, Chan MCW, To K‑F et al (2006) H. pylori genotypes and cytokine gene polymorphisms influence the development of gastric intestinal metaplasia in a Chinese population. Am J Gastroenterol 101:714–720. https://doi.org/10.1111/j.1572-0241.2006.00560.x
Leung WK, Ng EKW, Chan WY et al (2005) Risk factors associated with the development of intestinal metaplasia in first-degree relatives of gastric cancer patients. Cancer Epidemiol Biomarkers Prev 14:2982–2986. https://doi.org/10.1158/1055-9965.EPI-05-0181
Lomba-Viana R, Dinis-Ribeiro M, Fonseca F et al (2012) Serum pepsinogen test for early detection of gastric cancer in a European country. Eur J Gastroenterol Hepatol 24:37–41. https://doi.org/10.1097/MEG.0b013e32834d0a0a
Malfertheiner P, Link A, Selgrad M (2014) Helicobacter pylori: perspectives and time trends. Nat Rev Gastroenterol Hepatol 11:628–638. https://doi.org/10.1038/nrgastro.2014.99
Malfertheiner P, Megraud F, O’Morain CA et al (2017) Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut 66:6–30. https://doi.org/10.1136/gutjnl-2016-312288
Marques-Silva L, Areia M, Elvas L, Dinis-Ribeiro M (2014) Prevalence of gastric precancerous conditions. Eur J Gastroenterol Hepatol 26:378–387. https://doi.org/10.1097/MEG.0000000000000065
Mera RM, Bravo LE, Camargo MC et al (2017) Dynamics of Helicobacter pylori infection as a determinant of progression of gastric precancerous lesions: 16-year follow-up of an eradication trial. Gut. https://doi.org/10.1136/gutjnl-2016-311685
Minalyan A, Benhammou JN, Artashesyan A et al (2017) Autoimmune atrophic gastritis: current perspectives. Clin Exp Gastroenterol 10:19–27. https://doi.org/10.2147/CEG.S109123
Rokkas T, Pistiolas D, Sechopoulos P et al (2007) The long-term impact of Helicobacter pylori eradication on gastric histology: a systematic review and meta-analysis. Helicobacter 12(Suppl 2):32–38. https://doi.org/10.1111/j.1523-5378.2007.00563.x
Rokkas T, Rokka A, Portincasa P (2017) A systematic review and meta-analysis of the role of Helicobacter pylori eradication in preventing gastric cancer. Ann Gastroenterol 30:414–423. https://doi.org/10.20524/aog.2017.0144
Rugge M, de Boni M, Pennelli G et al (2010) Gastritis OLGA-staging and gastric cancer risk: a twelve-year clinico-pathological follow-up study. Aliment Pharmacol Ther 31:1104–1111. https://doi.org/10.1111/j.1365-2036.2010.04277.x
Rugge M, Correa P, Di Mario F et al (2008) OLGA staging for gastritis: a tutorial. Dig Liver Dis 40:650–658. https://doi.org/10.1016/j.dld.2008.02.030
Seta T, Takahashi Y, Noguchi Y et al (2017) Effectiveness of Helicobacter pylori eradication in the prevention of primary gastric cancer in healthy asymptomatic people: a systematic review and meta-analysis comparing risk ratio with risk difference. PLoS ONE 12:e183321. https://doi.org/10.1371/journal.pone.0183321
Shin WG, Kim HU, Song HJ et al (2012) Surveillance strategy of atrophic gastritis and intestinal metaplasia in a country with a high prevalence of gastric cancer. Dig Dis Sci 57:746–752. https://doi.org/10.1007/s10620-011-1919-0
Teng AM, Blakely T, Baker MG, Sarfati D (2016) The contribution of Helicobacter pylori to excess gastric cancer in indigenous and Pacific men: a birth cohort estimate. Gastric Cancer. https://doi.org/10.1007/s10120-016-0671-8
Toh B‑H (2014) Diagnosis and classification of autoimmune gastritis. Autoimmun Rev 13:459–462. https://doi.org/10.1016/j.autrev.2014.01.048
Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108. https://doi.org/10.3322/caac.21262
Uemura N, Okamoto S, Yamamoto S et al (2001) Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 345:784–789. https://doi.org/10.1056/NEJMoa001999
Venerito M, Malfertheiner P (2015) Preneoplastic conditions in the stomach: always a point of no return? Dig Dis 33:5–10. https://doi.org/10.1159/000369185
de Vries AC, van Grieken NCT, Looman CWN et al (2008) Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology 134:945–952. https://doi.org/10.1053/j.gastro.2008.01.071
de Vries AC, Kuipers EJ, Rauws EAJ (2009) Helicobacter pylori eradication and gastric cancer: when is the horse out of the barn? Am J Gastroenterol 104:1342–1345. https://doi.org/10.1038/ajg.2008.15
Wang J, Xu L, Shi R et al (2011) Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis. Digestion 83:253–260. https://doi.org/10.1159/000280318
Wong BC-Y, Lam SK, Wong WM et al (2004) Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 291:187–194. https://doi.org/10.1001/jama.291.2.187
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
M. Selgrad und M. Müller-Schilling geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Additional information
Redaktion
M. Ebert, Mannheim
M. Müller-Schilling, Regensburg
Rights and permissions
About this article
Cite this article
Selgrad, M., Müller-Schilling, M. Präneoplastische Bedingungen des Magens. Gastroenterologe 13, 121–125 (2018). https://doi.org/10.1007/s11377-018-0234-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11377-018-0234-0