Impaired response of gastric MALT-lymphoma to Helicobacter pylori eradication in patients with autoimmune disease

Background and aims: Gastric MALT-lymphoma is thought to be related to chro nic antigenic stimulation provided by Helicobacter pylori(HP). As clonal ex pansion of gastric B cells not related to HP has been demonstrated in patie nts with autoimmune disease (AD), we have analysed whether AD adversely inf luences response of MALT-lymphoma following HP-eradication. Patients and methods: Retrospective analysis of all patients with early sta ge gastric MALT-lymphoma treated with HP-eradication was performed. The pre sence of AD was evaluated by personal questioning for specific symptoms and serologically by analysis of rheumatoid factor, antinuclear antibodies and thyroid autoantibodies. Results: A total of 22 patients were identified receiving only antibiotic t reatment for initial management, and six presented with an autoimmune condi tion: three had Sjogren's syndrome, one polymyalgia rheumatica, one autoimm une thyroiditis along with psoriasis, and one patient had only autoimmune t hyroiditis. Successful eradication of HP was achieved in all patients, and 15 of 22 patients (68%) achieved complete response of the lymphoma, while n one out of the six patients with an autoimmune disorder responded to HP-era dication. Conclusion: Apart from questioning the role of HP in the development of lym phoma in such patients, these results suggest that patients with autoimmune disease might not be optimal candidates for HP-eradication even in case of early stage lymphoma.