Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3773
Peer-review started: September 3, 2014
First decision: October 29, 2014
Revised: November 18, 2014
Accepted: December 14, 2014
Article in press: December 16, 2014
Published online: April 7, 2015
Diffuse large B cell lymphoma (DLBCL) of the stomach is a heterogenous disease. There are tumors without histological evidence of mucosa-associated lymphoid tissue (MALT) lymphoma, which are classified as pure or de novo DLBCL and those with evidence of MALT, which are classified as DLBCL (MALT). The association between Helicobacter pylori (H. pylori) and gastric MALT lymphoma and remission with H. pylori eradication was shown in the 1990s. In recent years, scientists from Taiwan and others have shown that high-grade gastric lymphomas may be dependent on H. pylori and eradication of this microorganism is effective in these cases. This entity is biologically distinct from H. pylori (-) cases and has a better clinical outcome. There are sufficient data about the complete remission in some of these cases with brief treatment with antibiotics. With this strategy, it is possible to save some of these cases from the harmful effects of standard chemotherapy. It is time to treat these cases with H. pylori eradication. However, strict histopathological follow-up is crucial and histopathological response must be evaluated according to the scoring system proposed by Groupe d’Etude des Lymphomes de l’Adulte. If there is no sufficient response, chemotherapy must be given immediately. These results suggest that H. pylori dependency and high-grade transformation in gastric MALT lymphomas are distinct events.
Core tip: The association between Helicobacter pylori (H. pylori) and gastric mucosa-associated lymphoid tissue lymphoma has a long history and H. pylori eradication is the standard of care in these cases. In recent years, it has been shown that high-grade, early-stage gastric lymphoma may be dependent on H. pylori and eradication of this microorganism may be curative in some of the cases with gastric diffuse large B cell lymphoma. However, chemotherapy is a standard approach in cases unresponsive to H. pylori eradication.