Does Eradication of Helicobacter Pylori Reverse Atrophic Gastritis or Intestinal Metaplasia?: Data from Japan

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Helicobacter pylori infection causes development and progression of atrophic gastritis.7, 16 Atrophic gastritis and intestinal metaplasia (IM) have been considered precursor lesions of intestinal-type gastric cancer.3 Although inflammation in the gastric mucosa improves after eradication of H. pylori, whether eradication leads to the regression of atrophy and IM has not been decided. This issue has been investigated further in Japan, where the incidences of atrophic gastritis and gastric cancer are high. This article introduces the Japanese studies.

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CHANGE OF THE SEVERITY OF ATROPHY AFTER ERADICATION OF HELICOBACTER PYLORI

Opinion differs as to whether H. pylori eradication leads to the improvement or regression of atrophy. Tucci et al27 reported that the grades of body atrophy decreased significantly 12 months after eradication. Improvement of body atrophy also was reported in the study of Annibale et al1 6 months after eradication and that of Oberhuber et al18 2 months after eradication. van der Hulst et al31 had found no change of the degree of antral or body atrophy for 1 year after eradication, but more

CHANGE OF THE SEVERITY OF INTESTINAL METAPLASIA AFTER ERADICATION OF HELICOBACTER PYLORI

There is disagreement regarding the change of the severity of IM after eradication. Ciok et al2 reported that antral IM regressed in 61% of 23 patients 2 years after eradication. Ravizza et al19 found regression of IM at incisura angularis and the body in more than 30% of cases 2 years after eradication. In contrast, other studies showed no significant difference in the grades of antral8, 24, 27, 30, 31, 34 or body27, 31 IM between before and after therapy. Annibale et al1 showed that the

SUMMARY

In Japan, more reports showing improvement of atrophy or IM after eradication have appeared than reports showing no change. Many authors take biopsy specimens from the lesser and greater curvatures of the antrum and body and incisura angularis and make a histologic assessment using the standardized Updated Sydney System.4 Sampling errors should be taken into account, however. Interobserver agreement is poor in grading of atrophy. Apart from these problems, it seems almost certain that some

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    • Address reprint requests to Kiichi Satoh, MD Department of Gastroenterology Jichi Medical School Yakushiji, Tochigi 329-0498 Japan

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    Copyright © 2000 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.