Risk factors for gastric cancer diagnosed more than 10 years after eradication therapy of Helicobacter pylori

Abstract Introduction Risk factors for gastric cancer in the long-term post–Helicobacter pylori (H. pylori) eradication cohort remain unclear. This study aimed to identify risk factors for gastric cancer in the long-term post-eradication cohort. Methods We conducted a retrospective case–control study. Patients who underwent endoscopic submucosal dissection for gastric cancer diagnosed more than 10 years after eradication therapy were defined as the Gastric Cancer (GC) group. Patients who remained free of gastric cancer for more than 10 years after eradication therapy were defined as the No Gastric Cancer (NGC) group. We compared clinical and endoscopic findings between the two groups after propensity score matching for age, sex, and post-eradication period. Results A total of 105 patients in the GC group and 127 patients in the NGC group were included. After matching, 95 pairs were created. In the GC group, open-type atrophy (p < 0.001), severe intestinal metaplasia (p < 0.001), map-like redness (p = 0.002), and xanthomas (p = 0.005) were significantly more frequent, whereas history of gastric ulcer (p = 0.022), history of duodenal ulcer (p = 0.015), and fundic gland polyps (p = 0.006) were significantly less frequent. Multivariate analysis identified open-type atrophy (odds ratio [OR], 10.40; 95% confidence interval [CI], 4.57–23.80) and severe intestinal metaplasia (OR, 5.15; 95% CI, 2.06–12.90) as independent risk factors. Conclusion We demonstrated that open-type atrophy and severe intestinal metaplasia were independent risk factors for gastric cancer in patients more than 10 years after eradication therapy of H. pylori.