Gastroenterology

Gastroenterology

Volume 118, Issue 5, May 2000, Pages 821-828
Gastroenterology

Alimentary Tract
Helicobacter heilmannii–associated primary gastric low-grade MALT lymphoma: Complete remission after curing the infection,☆☆,

https://doi.org/10.1016/S0016-5085(00)70167-3Get rights and content

Abstract

Background & Aims: Cure of Helicobacter pylori infection may lead to complete remission of associated low-grade mucosa-associated lymphoid tissue (MALT) lymphoma in stage EI. This study investigated whether Helicobacter heilmannii infection–associated primary gastric MALT lymphoma will regress after cure of the infection. Methods: H. heilmannii–induced gastritis was diagnosed histologically, by a new specific immunoglobulin G enzyme-linked immunosorbent assay, and with 16S ribosomal RNA amplification and sequencing in 5 consecutive patients with primary gastric MALT lymphoma clinical stage EI. Patients received 40 mg omeprazole and 750 mg amoxicillin 3 times per day for 14 days. Polymerase chain reaction (PCR) was used to detect rearrangement of immunoglobulin heavy-chain genes before treatment and during follow-up. Results: Five patients (3 men, 2 women; mean age, 65 years; range, 42–79 years) were studied. H. pylori was not detected by culture, histology, serology, or PCR. Treatment resulted in the cure of H. heilmannii infection in each case and complete histological and endoscopic remission of the tumors. Three of 5 patients showed monoclonal B cells before treatment, 2 of whom remained PCR positive. Within a median follow-up period of 24 months, no relapse of the lymphoma or reinfection with H. heilmannii occurred. Conclusions: These data suggest that gastric MALT lymphoma may arise in patients with H. heilmannii infection. Cure of this infection may lead to complete remission of the MALT lymphoma.

GASTROENTEROLOGY 2000;118:821-828

Section snippets

Patients and methods

We investigated 5 patients with primary gastric low-grade MALT lymphoma associated with H. heilmannii (former Gastrospirillum hominis) infection. Lymphomas were detected in routine biopsy specimens sent to our central pathologist (M.S.). At that time, the referring physicians were asked to enroll the patients according to the study protocol, as described previously.15 Briefly, at all endoscopic examinations before and after treatment, 2 biopsy specimens were obtained from the antrum and 2 from

Clinical data

Five patients with H. heilmannii–associated primary gastric low-grade MALT lymphoma aged 42, 60, 71, 75, and 79 years (3 men, 2 women) were studied (Table 1).

. Baseline characteristics of 5 patients with H. heilmannii–associated MALT lymphoma

Sex (M/F)3/2
Median age, yr (range)71 (42–79)
Tumor stage EI5
Localization of lymphoma
 Antrum3
 Corpus2
Endoscopic appearance
 Tumor5
Median tumor size, cm (range)1 (1–4)
All patients complied with the study protocol.

Treatment results

The first course of treatment cured H. heilmannii

Discussion

We report clinical, microbiological, and molecular results on primary gastric MALT lymphoma associated with H. heilmannii infection. Antibiotic treatment of the organism, as established for H. pylori infection,23 resulted in its disappearance, and eradication of H. heilmannii resulted in complete remission of the MALT lymphoma in all 5 patients. According to recent studies that have linked chronic H. pylori infection to the development of MALT lymphoma,9, 10, 11, 14, 15, 21 this finding

Acknowledgements

The authors thank Prof. Adrian Lee, Sydney, Australia, for critically reading the manuscript and Prof. Joseph Eisenburg, Munich, Germany, for his help in the preparation of this study. They also thank Dr. W. Ordnung, Specialist in Internal Medicine, Bad Kissingen, Germany, for his support during the study, and Astra (Wedel, Germany) for supplying omeprazole 40-mg capsules (Antra forteR).

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    Address requests for reprints to: Andrea Morgner, M.D., Medical Department I, Technical University of Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany. e-mail: [email protected]; fax: (49) 351-458-4394.

    ☆☆

    Supported by funds from the the Deutsche Krebshilfe (70-225I).

    This paper is dedicated to the pathologist Prof. Konrad Ludwig Heilmann, who passed away in 1991.

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