Long term follow up of patients treated for Helicobacter pylori infection

Robertino Mera ¹, Elizabeth T.H. Fontham ¹, Luis Eduardo Bravo ², Juan Carlos Bravo ², Maria Blanca Piazuelo ¹, Maria Constanza Camargo ¹ and Pelayo Correa ^1*

¹ Louisiana State University Health Sciences Center, United States
² Universidad del Valle, Colombia

^* To whom correspondence should be addressed. E-mail: correa{at}lsuhsc.edu.

Accepted 8 June 2005

Abstract

Background: Helicobacter pylori (HP) infection induces progressive inflammatory changes in the gastric mucosa that may lead to gastric cancer. Understanding long-term effects resulting from the cure of this infection is needed to design cancer prevention strategies.

Methods: A cohort of 795 adults with preneoplastic gastric lesions was randomized to receive anti-HP treatment and/or antioxidants. At the end of 6 years of intervention, those who did not receive anti-HP treatment were offered it. Gastric biopsies were obtained at baseline, 3, 6 and 12 years. A histopathology score was utilized to document changes of gastric lesions. Non- linear mixed models were used to estimate the cumulative effect of HP clearance on histopathology scores adjusted for follow-up time, interventions, and confounders.

Results: Ninety-seven percent of subjects were HP positive at baseline, and 53% were positive at 12 years. Subjects accumulated 1,703 person-years free of the infection. A multivariate model showed a significant regression in the histopathology score as a function of the square of HP negative time. Subjects who were HP negative had 14.8% more regression and 13.7% less progression than patients who were positive at 12 years (p= 0.001). The rate of healing of gastric lesions occurs more rapidly as one accumulates years free of infection, and is more pronounced in less advanced lesions.

Conclusions: Preneoplastic gastric lesions regress at a rate equal to the square of time in patients rendered free of HP infection. Our findings suggest that patients with preneoplastic gastric lesions should be treated and cured of their HP infection.

Keywords: Helicobacter pylori, dysplasia, gastric atrophy, metaplasia, randomized trial

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Authors’ reply

Robertino Mera, Elizabeth T H Fontham, Luis E Bravo, Juan C Bravo, Maria Blanca Piazuelo, Maria Constanza Camargo, and Pelayo Correa
Gut 2007 56: 436. [Extract] [Full Text] [PDF]

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