Previous Helicobacter pylori infection–induced atrophic gastritis: A distinct disease entity in an understudied population without a history of eradication

Hiroshi Kishikawa, Keisuke Ojiro, Kenji Nakamura, Tadashi Katayama, Kyoko Arahata, Sakiko Takarabe, Soichiro Miura, Takanori Kanai, Jiro Nishida

Research output: Contribution to journalReview articlepeer-review

44 Citations (Scopus)


Individuals with chronic atrophic gastritis who are negative for active H. pylori infection with no history of eradication therapy have been identified in clinical practice. By excluding false-negative and autoimmune gastritis cases, it can be surmised that most of these patients have experienced unintentional eradication of H. pylori after antibiotic treatment for other infectious disease, unreported successful eradication, or H. pylori that spontaneously disappeared. These patients are considered to have previous H. pylori infection–induced atrophic gastritis. In this work, we define these cases based on the following criteria: absence of previous H. pylori eradication; atrophic changes on endoscopy or histologic confirmation of glandular atrophy; negative for a current H. pylori infection diagnosed in the absence of proton-pump inhibitors or antibiotics; and absence of localized corpus atrophy, positivity for autoantibodies, or characteristic histologic findings suggestive of autoimmune gastritis. The risk of developing gastric cancer depends on the atrophic grade. The reported rate of developing gastric cancer is 0.31%-0.62% per year for successfully eradicated severely atrophic cases (pathophysiologically equal to unintentionally eradicated cases and unreported eradicated cases), and 0.53%-0.87% per year for spontaneously resolved cases due to severe atrophy. Therefore, for previous H. pylori infection–induced atrophic gastritis cases, we recommend endoscopic surveillance every 3 years for high-risk patients, including those with endoscopically severe atrophy or intestinal metaplasia. Because of the difficulty involved in the endoscopic diagnosis of gastric cancer in cases of previous infection, appropriate monitoring of the high-risk subgroup of this understudied population is especially important.

Original languageEnglish
Article numbere12669
Issue number1
Publication statusPublished - 2020 Feb 1


  • Helicobacter pylori diagnosis
  • Helicobacter pylori infection
  • chronic atrophic gastritis
  • endoscopy
  • eradication
  • gastric autoimmune diseases

ASJC Scopus subject areas

  • Gastroenterology
  • Infectious Diseases


Dive into the research topics of 'Previous Helicobacter pylori infection–induced atrophic gastritis: A distinct disease entity in an understudied population without a history of eradication'. Together they form a unique fingerprint.

Cite this