Atrophy and intestinal metaplasia one year after cure of H. pylori infection: A prospective, randomized study

Background & Aims:Helicobacter pylori–infected gastric mucosa evolves through stages of chronic gastritis, intestinal metaplasia (IM), glandular atrophy (GA), and dysplasia before carcinoma develops. We studied if H. pylori eradication would alter the course of premalignant histologic changes in...

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Published in:	Gastroenterology (New York, N.Y. 1943) Vol. 119; no. 1; pp. 7 - 14
Main Authors:	Sung, Joseph J.Y., Lin, San–Rin, Ching, Jessica Y.L., Zhou, Li–Ya, To, Kar F., Wang, Ren–Ten, Leung, Wai K., NG, Enders K.W., Lau, James Y.W., Lee, Yuk T., Yeung, Chung K., Chao, William, Sydney Chung, S.C.
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-07-2000 Elsevier
Subjects:	Adult Aged Amoxicillin - therapeutic use Anti-Bacterial Agents - therapeutic use Atrophy Bacterial diseases Bacterial diseases of the digestive system and abdomen Biological and medical sciences Clarithromycin - therapeutic use Endoscopy Female Gastric Mucosa - microbiology Gastric Mucosa - pathology Gastroscopy Helicobacter Infections - pathology Helicobacter pylori Human bacterial diseases Humans Infectious diseases Intestines - pathology Male Medical sciences Metaplasia Middle Aged Omeprazole - therapeutic use Penicillins - therapeutic use Prospective Studies OAC PMN RUT GA IM UBT Human Stomach Carcinoma Spirillales Atrophic gastritis Spirillaceae Histology Malignant tumor Incidence Infection Pathology Randomization Helicobacter pylori Geographic distribution Intestinal metaplasia Placebo Bacteriosis Digestive diseases Bacteria Clinical trial Gastric disease
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Summary:	Background & Aims:Helicobacter pylori–infected gastric mucosa evolves through stages of chronic gastritis, intestinal metaplasia (IM), glandular atrophy (GA), and dysplasia before carcinoma develops. We studied if H. pylori eradication would alter the course of premalignant histologic changes in the stomach. Methods: Volunteers from the Yantai County in China underwent upper endoscopy with biopsy specimens obtained from the antrum and corpus. H. pylori–infected subjects were randomized to receive either a 1-week course of omeprazole, amoxicillin, and clarithromycin (OAC) or placebo. At 1 year, endoscopies with biopsies were repeated. Results: A total of 587 H. pylori–infected subjects were randomized to OAC (n = 295) and placebo (n = 292). At 1 year, H. pylori was eradicated in 226 subjects assigned to OAC. In the placebo group, 245 patients remained H. pylori infected. Analysis of paired samples obtained from the same patients showed that acute and chronic gastritis decreased in both the antrum and corpus after H. pylori eradication (P < 0.001) and activity of IM decreased in antrum (P = 0.014). In the H. pylori–infected group, antral biopsy specimens had more pronounced acute gastritis (P = 0.01), whereas corpus specimens showed increased acute and chronic gastritis (P < 0.001) and a marginal increase in GA (P = 0.052). When histologic changes were compared between the 2 groups, decrease in acute and chronic gastritis was more frequent after H. pylori eradication (P < 0.001) but changes in IM were similar. In the H. pylori–infected group, increase in GA was seen in the corpus (P = 0.01). Conclusions: At 1 year, H. pylori eradication is beneficial in preventing progression of pathologic changes of the gastric mucosa. GASTROENTEROLOGY 2000;119:7-14
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0016-5085 1528-0012
DOI:	10.1053/gast.2000.8550