Pathological gastric changes reversible after H pylori eradication

  • Aliment Pharmacol Ther

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Given several years, atrophic gastritis (AG) or intestinal metaplasia (IM) in patients with Helicobacter pylori (HP) can resolve completely after eradication of the organism.

Why this matters

  • Why HP eradication reduces risk for gastric cancer (GC) is unclear, as is whether AG or IM can regress after eradication.

Study design

  • Prospective case-control study of 1649 Korean adults who either had gastrointestinal symptoms or were undergoing GC surveillance.
  • To evaluate for AG and IM, esophagogastroduodenoscopy and biopsies were performed at baseline (n=1649) and for 1-10 years afterward (n=948).
  • HP-positive participants underwent eradication therapy.
  • HP-negative, HP-eradicated, and HP-noneradicated patients compared with regard to AG and IM regression.
  • Funding: South Korean government.

Key results

  • Excluding 350 participants with gastric dysplasia or GC on follow-up, 598 were analyzed.
  • AG improved vs baseline in HP-eradicated group (P<.001 all points>
  • Significant baseline differences vs the HP-negative group disappeared after >1 year of follow-up; and
  • No significant changes seen vs baseline in HP-negative or HP-noneradicated groups.
  • IM also improved vs baseline in HP-eradicated group (for antrum and corpus; P<.001 all points>
  • Baseline IM differences vs HP-negative group disappeared after 3 years of follow-up for corpus, ≥5 years of follow-up for antrum.
  • Limitations

    • Many participants lost to follow-up.