We report on a 51-year-old women, who suffered from a low-grade lymphoma of the stomach (MALT-lymphoma) and underwent subtotal gastrectomy in 1991. Two years later she developed a relapse of her MALT-lymphoma. She was treated with two Helicobacter pylori eradication therapies which led to complets remission of the lymphoma. In 1994 she developed a high-grade conchal lymphoma and underwent conchotomy. No moleculargenetic evidence of any relationship between the two lymphomas was found.

BACKGROUND:Several studies have shown that treatment with omeprazole leads to aggravation of Helicobacter pylori gastritis in the corpus. Whether this also applies to lansoprazole, and whether, in comparison with omeprazole, there are differences in therapy-induced gastritis parameter changes remains unclear.METHODS:In 111 patients infected with H. pylori and with gastro-oesophageal reflux disease we investigated the gastritis parameters in antral and corpus mucosa before and after 2, 6 and 12 months of treatment with 15 or 30 mg lansoprazole or 20 mg omeprazole/day.RESULTS:In all groups the different treatments had a similar effect: in both regions of the stomach, suppression or partial elimination of H. pylori was seen. However, improvement in the inflammation was observed only in the antrum, while in the corpus most gastritis parameters worsened significantly. There was no increase in intestinal metaplasia or atrophy.CONCLUSION:In common with omeprazole, lansoprazole aggravates the gastritis parameters in the corpus but improves them in the antrum. Treatment with proton pump inhibitors does not result in any increase in the incidence of atrophy/intestinal metaplasia. However, as gastritis predominating in the corpus seems to be associated with an elevated carcinogenic risk, consideration should be given to prophylactic H. pylori eradication therapy before initiating proton pump inhibitor treatment.

Background & Aims: Recent studies suggest that eradication of Helicobacter pylori may result in complete regression of low-grade lymphoma of the gastric mucosa-associated lymphoid tissue (MALT), Which patients benefit from this treatment is unknown. The aim of this study was to prospectively study whether staging by echoendoscopy predicts the outcome of treatment of MALT lymphoma by eradication of H. pylori. Methods: Twenty-two patients positive for H. pylori with low-grade gastric B-cell MALT lymphoma were examined by echoendoscopy at the time of diagnosis, Treatment for H. pylori consisted of a 2-week course of oral I omeprazole and amoxicillin. Patients were followed up by endoscopy and biopsy. Results: H. pylori was eradicated in all patients, Complete regression of MALT lymphoma was observed in 12 patients (54%), partial regression in 5 patients (23%), and no response in 5 patients (23%) during follow-up, Twelve of 14 patients with lymphoma restricted to the mucosa or submucosa (stage E-I-1) at echoendoscopy, but none of the 10 patients with higher stage (P < 0.01), showed complete regression of MALT lymphoma. In stage E-I-1 patients, the probability of complete regression of lymphoma was 60% at 6, 79% at 12, and reached 100% at 14 months, respectively, Conclusions: Staging of gastric low-grade MALT lymphomas by endoscopic ultrasonography allows prediction of the response to therapy by eradication of H. pylori.

Lymphome sind maligne klonale Erkrankungen des lymphatischen Gewebes. Man unterscheidet die häufigeren nodalen von den selteneren extranodalen Lymphomen. Es wurde insbesondere von R Isaacson erkannt, daß in Epithelzellen tragenden Organen entstehende Lymphome sich biologisch häufig völlig anders verhalten als nodale Lymphome (Isaacson u. Wright 1983,1984; Isaacson u. Spencer 1987). Diese primär in Schleimhäuten auftretenden Lymphome sind maligne, klonale Entartungen des Mukosa-assoziierten lymphatischen Gewebes (MALT) und werden daher MALT-Lymphome genannt. Ebenso wie bei nodalen Lymphomen werden bei den MALT-Lymphomen hochmaligne von niedrigmalignen unterschieden. Weitaus am häufigsten treten MALT-Lymphome im Magen auf. Hier sind wiederum die niedrigmalignen führend und machen ca. 85–90% aller im Magen diagnostizierten Lymphome aus (Isaacson 1994,1995; Isaacson u. Spencer 1995).

PURPOSE The differential diagnosis of early gastric mucosa-associated lymphatic tissue (MALT) lymphoma based on Helicobacter pylori gastritis may be difficult when lymphoepithelial lesions are not detected. The aim of the present study was to investigate the question whether the polymerase chain reaction (PCR) or cure of H pylori infection may be of help in this respect. PATIENTS AND METHODS Twenty patients with suspected low-grade gastric MALT lymphomas were treated in a double-blinded, randomized, crossover trial with 2,250 mg of either amoxicillin or placebo, both in combination with omeprazole, for 14 days with the aim to cure H pylori infection. PCR was performed using primers specific for the CDR3 region to detect monoclonal B cells. RESULTS In five of 20 patients, MALT lymphomas were finally diagnosed. Three of these five patients went into complete remission, while two were referred to surgery. In the 15 patients with gastritis, complete regression was observed in all cases. With respect to PCR, monoclonal bands were detected in all four of the analyzed lymphoma patients before histology showed lymphoma. In addition, monoclonal bands were found in three patients with gastritis. In the patients with gastritis and monoclonal PCR, complete regression took longer as compared with the remaining 12 patients with polyclonal PCR and gastritis (P = .0209). Successful H pylori eradication was associated with earlier diagnosis of the MALT lymphoma (P = .0237). CONCLUSION CDR3-PCR may be of help in the differential diagnosis of early gastric MALT lymphoma. Furthermore, H pylori eradication may lead to earlier diagnosis.