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—We appreciate the interesting letter and contribution by Dr DeGerome to the accumulating observations that are defining the relationship between H pylori and gastric MALT lymphoma. Our report, in addition to establishing a progression from gastritis to lymphoma, suggests that H pylori has only an indirect role in the development of the lymphoma. At some point, the lymphoma can progress independent of H pylori.DeGerome's illustrative case appears to provide further evidence that H pylori alone is not the direct factor in the progression of the MALT lymphoma. H pylori is important initially, possibly by inducing an immunologic injury that lowers the threshold for the development of lymphoma in these susceptible individuals.Based on the observations of patients such as ours and DeGerome's, it is clear that merely eradicating H pylori does not guarantee either resolution or lack of recurrence. Therefore, we agree wholeheartedly that long-term follow-up with extensive
Vanagunas A, Carlson SJ. Helicobacter pylori and Mucosa-Associated Lymphoid Tissue Lymphoma-Reply. JAMA. 1996;276(13):1034-1035. doi:10.1001/jama.1996.03540130032016