Gastric malt lymphomas: the value of an endoscopic follow-up evaluation

Background: Findings have demonstrated the close association between primar y gastric B-cell lymphomas originating from mucosa-associated lymphoid tiss ue (MALT) and Helicobacter pylori (HP) infection, with their regression aft er an HP eradication therapy in up to 70% of the cases. Endoscopic-biopsy d iagnosis and endoscopic ultrasound are of major importance as decisive prog nostic factors and therapeutic determinants. Objectives: We report 3 years of experience and follow-up evaluation in the management of MALT lymphomas. We also describe the guidelines strategy the rapy used in our institution. Methods: Since July 1996, nine patients with a histologic diagnosis of low- grade, HP-positive MALT gastric lymphomas, have been followed up. All patie nts had stage IE lymphomas (according to Musshoff classification). Eradicat ion of HP was performed with triple therapy amoxycillin, clarithromycin, an d omeprazole using over a 14-day period. The patients were seen for endosco pic follow-up assessment after 3, 6, 9, and 15 months, then twice a year. T he actual median follow-up time was 30.4 months (range, 16-38 months). Results: All the patients are now free of disease and asymptomatic. We have registered two cases of HP relapse (both after 1-year follow-up evaluation ), positively treated with the same triple therapy, and three cases of dise ase relapse treated with single-dose chemotherapy (plus radiotherapy in one patient). Conclusions: In our experience the eradication of HP appears to be effectiv e, and we consider it the first therapeutic option in patients with stage I E gastric low-grade MALT lymphoma, although long-term results are still nee ded. Prolonged follow-up evaluation (particularly by endoscopy) is necessar y (and feasible in our experience) to determine whether these remissions ar e long-lasting. We recommend that HP be eradicated in these lymphomas befor e referral to other standard treatment.