Reversal Phenomenon on the Mucosal Borderline Relates to Development of Gastric Cancer after Successful Eradication of H. pylori

Yoshitaka Nawata, Kazuyoshi Yagi, Megumi Tanaka, Atsuo Nakamura


AIM: The characteristic endoscopic features of the gastric mucosa predictive of cancer development after successful eradication of H. Pylori have not been fully clarified. We have previously reported a reversal of red and white coloration in gastric corpus in some patients after eradication, and referred to it as the “reversal phenomenon on the mucosal borderline” (RP), which is often evident in patients who develop gastric cancer after eradication. Therefore we conducted a cross-sectional study to evaluate the correlation between RP and gastric cancer after H. Pylori eradication, and examined RP histologically.

MATERIALS AND METHODS: Patients with a history of successful eradication who underwent esophago-gastro-duodenoscopy (EGD) in our hospital between November 2015 and January 2016 were prospectively enrolled. The numbers of newly diagnosed cancers in RP-positive and negative groups were assessed. In addition, both red and white areas in the RP-positive patients were scrutinized by narrow-band imaging with magnifying endoscopy (NBI-ME), and histologically assessed by taking biopsy specimens.

RESULTS: Eighty-five patients were analyzed. Among them, 28 (32.9%) showed RP. Six cancers were found in the RP-positive group, and one in the RP-negative group (p<0.01). NBI-ME showed round pits without a light blue crest (LBC) in white areas, and round pits with LBC or villus-like structures with LBC or white opaque substance in red areas. All biopsy specimens from white areas had fundic glands, and all from red areas showed intestinal metaplasia.

COCLUSION: Patients with RP tend to develop gastric cancer after eradication.


Gastric cancer, H. Pylori, Eradication therapy, Magnifying endoscopy, Narrow-band imaging

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