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World J Gastroenterol. Mar 21, 2014; 20(11): 2751-2759
Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.2751
Helicobacter pylori infection in gastric mucosa-associated lymphoid tissue lymphoma
Jeong Bae Park, Ja Seol Koo
Jeong Bae Park, Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju 780-350, South Korea
Ja Seol Koo, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 425-707, South Korea
Author contributions: Park JB and Koo JS contributed equally to this work; all authors approved the final version of the manuscript.
Correspondence to: Dr. Ja Seol Koo, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan 425-707, South Korea. jskoo@korea.ac.kr
Telephone: +82-31-4125580 Fax: +82-31-4125582
Received: August 16, 2013
Revised: October 15, 2013
Accepted: November 1, 2013
Published online: March 21, 2014
Abstract

Gastrointestinal lymphoma is the most common type of extranodal lymphoma, and most commonly affects the stomach. Marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphoma are the most common histologic types of gastric lymphoma. Despite its increasing incidence, diagnosis of gastric lymphoma is difficult at an earlier stage due to its nonspecific symptoms and endoscopic findings, and, thus, a high index of suspicion, and multiple, deep, repeated biopsies at abnormally and normally appearing sites in the stomach are needed. In addition, testing for Helicobacter pylori (H. pylori) infection and endoscopic ultrasonography to determine the depth of tumor invasion and involvement of regional lymph nodes is essential for predicting response to H. pylori eradication and for assessment of disease progression. In addition, H. pylori infection and MALT lymphoma development are associated, and complete regression of low-grade MALT lymphomas after H. pylori eradication has been demonstrated. Radiotherapy and/or chemotherapy can be used in cases that show poor response to H. pylori eradication, negativity for H. pylori infection, or high-grade lymphoma.

Keywords: Mucosa-associated lymphoid tissue, Lymphoma, Helicobacter pylori, Eradication, Remission

Core tip: The incidence of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is increasing; however, early diagnosis is still difficult. Early detection and accurate stage workup is essential for treatment of MALT lymphoma. If gastric lymphoma is verified, testing for Helicobacter pylori infection, bone marrow biopsy, chest radiographs, endoscopic ultrasonography, and computed tomography scans should be performed for staging. We reviewed the most recent literature and provide a comprehensive summary of the diagnosis, treatment according to each stage, and follow-up on this topic.