In the chapter, an analysis of the literature on the relationship between Helicobacter pylori, the use of
proton pump inhibitors and the development of
atrophic gastritis is presented, and the difficulties of classifying
gastritis and the new possibilities of quantifying chronic
inflammation by morphometric analysis are discussed. The issue surrounding the necessity of eradicating H. pylori in H. pylori-positive patients has still not been solved. Most studies have now accepted that
proton pump inhibitors indeed accelerate the onset of
atrophic gastritis in H. pylori-positive patients, but evidence against such an association was published in one recent (Scandinavian) study; conclusions from this study have, however, been challenged by several groups. Some data are available on the efficacy of H. pylori eradication with regard to the prevention of
atrophy. The limited significance of the development of parietal cell protrusions and fundic gland
cysts is better understood, but much less is known of the development and long-term consequence of H. pylori-induced autoimmune
gastritis. Finally, recent studies in H. pylori-positive patients indicate that treatment with
proton pump inhibitors may promote bacterial N-nitrosation formation. These data taken together suggest that the eradication of H. pylori may be based not only on morphological arguments, but also on bacterial alterations in the gastric milieu.