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The natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: the Sørreisa gastrointestinal disorder study

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Abstract

The natural course of Helicobacter pylori (H. pylori) is poorly understood, as most research in the field has been on patient populations. We studied the natural course of H. pylori and its associations to morphological changes of the gastric mucosa, peptic ulcer, and reflux oesophagitis in a prospective cohort study of subjects with and without dyspepsia. A total of 361 adults (201 men/160 women, mean age 41/42 years) in Sørreisa municipality, Norway who in 1987 were subjected to upper endoscopy and assessed for gastrointestinal symptoms and H. pylori status were followed up in 2004. H. pylori was strongly associated with neutrophilic (odds ratio [OR] 23.79; 95% confidence interval [CI] 11.64:48.61) and mononuclear infiltration (OR 9.43; CI 5.12:17.36), moderately with atrophy of the antrum (OR 1.98; CI 1.17:3.34), but not with atrophy of the gastric body or intestinal metaplasia. Elimination of H. pylori was associated with regression of gastric inflammation and atrophy, whereas intestinal metaplasia progressed. H. pylori was positively associated with peptic ulcer (OR 2.69; CI 1.2:6.02) but not significantly negatively associated with oesophagitis (OR 0.62; CI 0.35:1.09). This is the first prospective study including endoscopic findings of subjects without dyspepsia, to show that the impact of H. pylori on gastric atrophy is only modest, and that eliminating H. pylori does not cause regression of intestinal metaplasia. However, inflammation of the gastric mucosa regresses after H. pylori elimination. H. pylori is only a moderate risk factor for peptic ulcer, and other explanatory factors deserve more attention.

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Abbreviations

ASA:

Acetylsalicylic acid

CI:

Confidence interval

GORD:

Gastro-oesophageal reflux disease

H. pylori :

Helicobacter pylori

NSAIDs:

Non-steroid anti-inflammatory drugs

OR:

Odds ratio

PU:

Peptic ulcer

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Acknowledgments

The study was jointly funded by EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, National Association for Digestive Diseases, Northern Norway Regional Health Authority and the University of Tromsø. The authors’ work was independent of the founders.

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Authors and Affiliations

  1. Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway

    Anne Mette Asfeldt, Maja-Lisa Løchen, Bjørn Straume & Roar Johnsen

  2. Department of Pathology, University Hospital of North Norway, Tromsø, Norway

    Sonja Eriksson Steigen

  3. Department of Medical Biology, University of Tromsø, Tromsø, Norway

    Sonja Eriksson Steigen

  4. Department of Cardiology, University Hospital of North Norway, Tromsø, Norway

    Maja-Lisa Løchen

  5. Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway

    Roar Johnsen

  6. Helgeland Hospital, Mo i Rana, Norway

    Bjørn Bernersen

  7. Department of Clinical Medicine, University of Tromsø, Tromsø, Norway

    Jon Florholmen & Eyvind J. Paulssen

  8. Department of Gastroenterology, University Hospital of North Norway, Tromsø, Norway

    Jon Florholmen & Eyvind J. Paulssen

Authors
  1. Anne Mette Asfeldt
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  2. Sonja Eriksson Steigen
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  3. Maja-Lisa Løchen
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  4. Bjørn Straume
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  5. Roar Johnsen
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  6. Bjørn Bernersen
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  7. Jon Florholmen
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  8. Eyvind J. Paulssen
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Correspondence to Anne Mette Asfeldt.

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Asfeldt, A.M., Steigen, S.E., Løchen, ML. et al. The natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: the Sørreisa gastrointestinal disorder study. Eur J Epidemiol 24, 649–658 (2009). https://doi.org/10.1007/s10654-009-9371-6

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  • DOI: https://doi.org/10.1007/s10654-009-9371-6

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