Outcome of gastric atrophy and intestinal metaplasia in patients with or without Helicobacter pylori infection during a ten year follow-up

Abstract

Chronic atrophic gasmtis and intestinal metaplasia, lesions always caused by Heiicobacter pylori (Hp), are considered the main steps m gasmc carcinogenesis The relative risk of cancer is directly related to the severity and extension of these preneopfastic conditions, However, it is debated whefl',.er or not bacterial eradication reverses these lesions interrupting the progression towards cancer. Several factors can explain these discrepancies i e population, gastroduodenal underling pathology, stud3, protocol etc. Aim: to evaluate the effect of Hp eradication therapy on gastric atrophy and intestmM metaplasia in a ,,veil selected population over a 10 yrs follow~up Patients and methods: Fifty-tour consecutive patients with duodenal ulcer and Hp inflection were enrdled in the study. Endo~opic examination with amral and corporal biopsy was done at baseline and at yearly intmval for 10 )'ear after eradication tbentpy (omeprazole 40 mg bid, amoxocylfin 1 g bid and cfarithmmycin 500 mg bid). Gastritis, atrophy, and rnetaplasia were graded according to the updated Sydney System The time trend of lesions was evaluated by logistic regression Resuhs: Thirtps~x patients were success[dlly eradicated by antibiotic therapy and 18 showed a persistenee of infection. This latter group was constituted by patients resistant to eradication therapy (n 5) or with poor compliance (n 4) and patients who refhsed antibiotic therapy (n 9) The two groups were age (64 +/-12) and sex reachable. During the tblIow-up, 12 patients in eradicated group (EG) and 8 patients in not eradicated glonp (NEG) dropped out. In EG patients the mucosal inflammation (lymphocytic and neutrophylic infiltrate) significamly decreased; gastric atrophy detected baseline in 17 out of 24 improved in 2 and disappeared in 7 in NEG gnmp Hp positive, mucosai intlammation persisted in all subjects, while gastric atrophy detected baseline in 7, worsened in 3 and appeared in 7 Intestinal metaplasia overall did not improve, when present, in both groups while in NEG, it developed in 5 case. Conclusion: In a Iong:term fi)llow-np, Hp eradication improves glandular atrophy and prevents intestinal metapfasia development