Gastrointestinal lymphoma: prevention and treatment of early lesions

Gastrointestinal lymphomas comprise a group of distinct clinicopathological entities. Differences in lifestyle and environmental factors between count ries could account for the variety in the distribution of the main subtypes : low-grade B-cell lymphomas of the mucosa-associated lymphoid tissue type, alpha-chain disease and enteropathy (coeliac disease)associated T-cell lym phoma (EATL). The possibility of preventing these lymphomas implies a knowl edge of their natural history together with an identification of potential predisposing factors. The development of the lymphoid hyperplasia and subse quently low-grade lymphoma with the possibility of high-grade transformatio n is a multifactorial process involving both antigenic and host-related fac tors. The pathogenic role of Helicobacter pylori and gluten has been demons trated in gastric lymphoma and enteropathy-associated T-cell lymphoma respe ctively, while environmental factors, especially non-specific bacterial one s, may play a major role in the pathogenesis of alpha-chain disease. The mo st difficult task in preventing these lymphomas is the recognition of early lesions likely to regress after the removal of the exogenous stimulus.