PERSPECTIVE article
Front. Microbiol.
Sec. Infectious Agents and Disease
This article is part of the Research TopicHelicobacter pylori: Evolution, Pathogenicity, and Implications for Gastric HealthView all articles
Stratified Management of Residual Gastric Cancer Risk After H. 1 pylori Eradication
Provisionally accepted
- Nantong Tumor Hospital, Nantong, China
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Despite the established efficacy of Helicobacter pylori eradication in reducing 12 gastric cancer (GC) incidence, a significant residual risk persists in successfully 13 treated individuals, driven by lasting pathological alterations termed "oncogenic 14 memory," including irreversible mucosal damage (e.g., intestinal metaplasia), residual 15 pro-inflammatory and epigenetic "molecular scars," and gastric microbiome dysbiosis. 16 This perspective synthesizes current evidence to advocate for a paradigm shift from a 17 singular focus on pathogen clearance towards a comprehensive, risk-adapted 18 management strategy. We propose a novel, dual-dimensional framework centered on a 19 multidimensional risk assessment that integrates OLGA/OLGIM staging, 20 demographic, lifestyle, and genetic factors to stratify post-eradication individuals into 21 distinct risk categories. The framework subsequently outlines tailored surveillance 22 protocols—specifying endoscopy frequency and advanced biomarker 23 application—leverages technological support from AI-assisted endoscopy and 24 molecular testing, and details differentiated resource allocation models based on 25 regional GC incidence and economic development. This integrated approach provides 26 a practical roadmap for implementing precision prevention, aiming to mitigate the 27 lingering GC risk and ultimately reduce the global disease burden through a dynamic, 28 lifelong management system beyond eradication.To facilitate implementation, we 29 provide a user-ready risk calculator (Excel and web-based; Supplementary Files) that 30 operationalizes the multidimensional score for cohort-level application.
Keywords: artificial intelligence, biomarkers, gastric cancer, Gastric microbiome, Helicobacter pylori eradication, OLGA/OLGIM, oncogenic memory, precision prevention
Received: 02 Jan 2026; Accepted: 21 Jan 2026.
Copyright: © 2026 Yu and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: QiYing Yu
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