Analyzing the influence of gastric intestinal metaplasia on gastric ulcer healing in Helicobacter pylori\u2013infected patients without atrophic gastritis

Rong-Nan Chien,Chung-Ching Hua,Bor-Jen Hsieh,Shuo-Wei Chen,Li-Wei Chen,Liang-Che Chang

doi:10.1186/s12876-016-0563-8

Rong-Nan Chien, Chung-Ching Hua + Show 4 more

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https://doi.org/10.1186/s12876-016-0563-8

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Journal: BMC Gastroenterology	Publication Date: Jan 3, 2017
Citations: 63	License type: open-access

Affiliation: Keelung Chang Gung Memorial Hospital

Abstract

BackgroundGastric epithelial hyper-proliferation was reported in patients with Helicobacter pylori (H. pylori)–infected gastric mucosa with intestinal metaplasia (IM) changes. In patients with gastric ulcer (GU) and IM, the GU may have a different healing rate in comparison to patients without IM. This study aimed to compare the difference in GU healing between H. pylori–infected patients with IM and those without IM.MethodsWe retrospectively analyzed patients at the Keelung Chung Gung Memorial Hospital during the period from March 2005 to January 2011. The inclusion criteria were: 1) endoscopic findings of GU and biopsy histological examination plus rapid urease test indicating H. pylori infection; 2) gastric IM adjacent to a GU but with no atrophic gastritis changes; 3) patients receiving H. pylori eradication triple therapy and 8 weeks of maintenance therapy with a proton pump inhibitor; and 4) patients receiving follow-up endoscopy within the 3rd and the 4th months after treatment.ResultsIn total, 327 patients with GU and H. pylori infection (136 with IM and 191 without IM) were included. Patients with IM had a higher GU healing rate than those without IM (91.9% vs. 84.3%, P = 0.040). Multivariate logistical regression analysis revealed that failure of H. pylori eradication (Odds = 4.013, 95% CI: 1.840–8.951, P < 0.001) and gastric IM (Odds = 0.369, 95% CI: 0.168–0.812, P = 0.013) were the predictors of non-healing GU following treatment.ConclusionsPatient with gastric IM change may have a higher GU healing rate than those without gastric IM. However, successful H. pylori eradication is a more important factor for GU healing than gastric IM.

Highlights

Gastric epithelial hyper-proliferation was reported in patients with Helicobacter pylori (H. pylori)– infected gastric mucosa with intestinal metaplasia (IM) changes
Because patients with atrophic mucosa in histological findings were excluded in this study, the majority of patients had minimal foci of IM and were scored as 0 or 1 (107/136, 78.7%) by using the Sydney system visual analog scale
As positive predictors for nonhealing GU (NHGU), the analysis revealed age [odds ratio (OR) =1.035, 95% confidence interval (CI) = 1.007–1.064; P = 0.015] and persistent H. pylori infection [OR = 3.924, 95% CI = 1.857–8.294, P < 0.001]

Summary

Introduction

Gastric epithelial hyper-proliferation was reported in patients with Helicobacter pylori (H. pylori)– infected gastric mucosa with intestinal metaplasia (IM) changes. In patients with gastric ulcer (GU) and IM, the GU may have a different healing rate in comparison to patients without IM. This study aimed to compare the difference in GU healing between H. pylori–infected patients with IM and those without IM. Intestinal metaplasia (IM) is a common finding in patients with Helicobacter pylori (H. pylori) infection. The prevalence of IM in patients with H. pylori infection is 30–40% in patients approximately 50 years old [1, 2]. Some studies revealed that the Wingless-Int (Wnt)/β catenin pathway plays an important role in the progression of H. pylori-related IM [3,4,5,6]. The Wnt signal transduction pathway is important in intestinal epithelial.

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