Letter to the Editor
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2021; 27(46): 8033-8039
Published online Dec 14, 2021. doi: 10.3748/wjg.v27.i46.8033
Surveillance strategies for precancerous gastric conditions after Helicobacter pylori eradication: There is still need for a tailored approach
Endrit Shahini, Marcello Maida
Endrit Shahini, Division of Gastroenterology, National Institute of Research "Saverio De Bellis", Castellana Grotte (Bari) 70013, Italy
Marcello Maida, Section of Gastroenterology, S.Elia - Raimondi Hospital, Caltanissetta 93017, Italy
Author contributions: Shahini E conducted study conceptualization, drafting the manuscript, data collecting, and curation; Maida M supervised; Shahini E and Maida M edited paper, critically reviewed the data entries for important intellectual content, checked for completeness of information; and both authors approved the final draft.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Endrit Shahini, MD, MSc, Division of Gastroenterology, National Institute of Research "Saverio De Bellis", Via Turi, 27, Castellana Grotte (Bari) 70013, Italy.endrit.shahini@irccsdebellis.it
Received: September 4, 2021
Peer-review started: September 4, 2021
First decision: October 2, 2021
Revised: October 3, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: December 14, 2021
Processing time: 96 Days and 15.8 Hours
Abstract

Prevailing evidence declares that Helicobacter pylori (H. pylori) eradication therapy could shift precancerous gastric conditions (PGC) and positively confines gastric cancer (GC) risk during long-term endoscopic follow-up. Nonetheless, there is a yet unsolved controversy regarding the best-individualized surveillance strategies following H. pylori eradication, based on malignant risk stratification. This last dispute is due to the uncertainty of contemporary evidence and the role of H. pylori inflammatory changes in underestimating PGC at the index endoscopy. However, the current state of the art suggests that it is reasonable that high-quality endoscopy with histological assessment for the most accurate diagnosis of PGC may be delayed in selected high-risk patients without alarm signs for malignancy, following the eradication of H. pylori. Notwithstanding, these aspects need to be further examined in the next future to establish and optimize the most beneficial and cost-effective strategies for recognizing and managing H. pylori-positive patients with PGC in the short- and long-term follow-up. Accordingly, additional studies are yet required to sharpen the hazard stratification of patients with the greatest chance of GC evolution, also recognizing the evolving racial, ethnic, immigration factors and the necessity of novel biomarkers to limit GC development or accomplish a diagnosis of malignancy at an early stage.

Keywords: Helicobacter pylori; Endoscopic surveillance; Atrophic gastritis; Intestinal metaplasia; Dysplasia; Gastric cancer

Core Tip: Prevailing evidence affirms that Helicobacter pylori (H. pylori) eradication therapy could shift precancerous gastric conditions and positively confines gastric cancer risk during long-term endoscopic follow-up. Nonetheless, there is a yet unsolved dispute concerning the most useful individualized surveillance strategies following H. pylori eradication, based on malignant risk stratification. These aspects should be examined in the next future to establish and optimize the most cost-effective strategies for recognizing and managing H. pylori-positive patients with precancerous gastric conditions in the short- and long-term follow-up. Accordingly, new studies are required to sharpen the hazard stratification of patients with the greatest chance of progressing into gastric cancer.