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

https://doi.org/10.1053/gast.2000.8550Get rights and content

Abstract

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

Section snippets

Patients and methods

The study was a collaborative study between the Chinese University of Hong Kong and the Beijing Medical University, approved by the Medical Ethics Committee of the Chinese University of Hong Kong. An endoscopic study was conducted in 11 rural villages around the county of Yantai in the Shangdong province. The location was chosen for the study for 2 reasons: Yantai is known to have a high incidence of gastric cancer (50 per 100,000 population), and rapport has been established between the local

Results

A total of 1024 subjects were screened in this study. Four subjects were considered unfit for examination because of comorbid medical conditions, and 2 subjects refused endoscopy. Endoscopic examination revealed 4 cases of gastric cancer, 1 case of esophageal cancer, and 25 cases with previous gastrectomy. These patients were excluded from randomization. In the remaining 988 subjects, 600 cases with a positive RUT result were randomized. In 13 RUT-positive subjects, H. pylori infection could

Discussion

H. pylori is one of the causative factors of gastric cancer. Its eradication may have an important role in the prevention of gastric cancer. The effect of H. pylori eradication on premalignant lesions of the stomach has intrigued many investigators worldwide. However, conflicting messages have been reported in previous studies. Genta et al.4 reported a minor decrease in the average grade of IM in 11 patients in the corpus 1 year after therapy. Haruma et al.5 followed up 20 patients for 6 months

Acknowledgements

The authors thank Ashley Lymee Yu for advice in statistical analysis and Olympus China for technical support.

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Address requests for reprints to: Joseph J. Y. Sung, M.D., Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, China. e-mail: [email protected]; fax: (852) 2646-7824.

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Supported by an unrestricted grant from the Hong Kong Society of Digestive Endoscopy.

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