Helicobacter pylori in the upper gastrointestinal tract: medical or surgical treatment of gastric lymphoma?

The treatment of primary gastric lymphoma is controversial. The role of surgery has come to be questioned with increasing knowledge about the pathogenesis of gastric lymphoma and with new therapeutic approaches such as eradication of Helicobacter pylori. We review published clinical trials of primary gastric lymphoma, including preliminary results of our own prospective multicenter trial. The results of 7 trials of H. pylori eradication and 12 prospective therapeutic trials trial are discussed. On basis of these data it is concluded that surgery with intention of R0 resection is the treatment of choice in stages EI2 and EII1 of low-grade lymphoma. In high-grade lymphomas it is still unclear whether surgery or its primary combination with radio- or chemotherapy should be preferred. The eradication of H. pylori is a promising therapeutic approach for localized low-grade mucosa-associated lymphoid tissue lymphoma. A randomized trial is needed to clarify whether medical or surgical management of localized gastric lymphoma or a combination of two is the best treatment modality.