Helicobacter pylori in the upper gastrointestinal tract: medical or surgical treatment of gastric lymphoma?

The treatment of primary gastric lymphoma is controversial. The role of sur gery has come to be questioned with increasing knowledge about the pathogen esis of gastric lymphoma and with new therapeutic approaches such as eradic ation of Helicobacter pylori. We review published clinical trials of primar y gastric lymphoma, including preliminary results of our own prospective mu lticenter trial. The results of 7 trials of H. pylori eradication and 12 pr ospective therapeutic trials trial are discussed. On basis of these data it is concluded that surgery with intention of RO resection is the treatment of choice in stages EI2 and EII1 of low-grade lymphoma. In high-grade lymph omas it is still unclear whether surgery or its primary combination with ra dio- or chemotherapy should be preferred. The eradication of H. pylori is a promising therapeutic approach for localized low-grade mucosa-associated l ymphoid tissue lymphoma. A randomized trial is needed to clarify whether me dical or surgical manage ment of localized gastric lymphoma or a combinatio n of two is the best treatment modality.