Changing patterns of Helicobacter pylori gastritis in long-standing acid suppression.

Abstract

BACKGROUND:

Helicobacter pylori colonization and associated inflammation are influenced by local acid output. Infected subjects with acid-related diseases, such as gastroesophageal reflux disease (GERD) are likely to have an antral-predominant gastritis. We hypothesized that long-term acid suppression would result in relatively greater bacterial colonization in the corpus leading to diffuse or corpus-predominant gastritis and that this would be prevented by prior H. pylori eradication.

MATERIALS AND METHODS:

To investigate this, we conducted a prospective, double-blind trial of the effect on gastric histology of 12-month maintenance treatment with omeprazole in H. pylori-positive GERD patients randomly assigned to either an eradication or omeprazole-alone regime. A control group of 20 H. pylori-negative GERD patients also received omeprazole throughout the study period. Biopsies taken at baseline and at 12 months were graded "blind" by a single observer according to the updated Sydney System. The 41 H. pylori-positive subjects with grade B or C esophagitis were randomly assigned (20 to omeprazole alone, 21 to eradication) and 33 subjects completed the 12-month study.

RESULTS:

There was a significant decline in antral chronic inflammation in initially positive patients between baseline and end in both the eradication group (p =.035) and the omeprazole-alone group (p =.008). However, corpus chronic inflammation increased in the omeprazole-alone group (p =.0156) but decreased in the eradication group. The change toward corpus predominance between baseline and end for the omeprazole-alone group is highly significant (p =.0078). Furthermore, 5 of 11 in the omeprazole-alone group developed mild corpus atrophy, compared to 0 of 8 who had undergone H. pylori eradication. The change in frequency of corpus atrophy between the two groups is significant (p =.02).

CONCLUSION:

In H. pylori-positive subjects with GERD, long-term acid suppression leads to a shift from antral- to corpus-predominant gastritis that can be prevented by prior eradication. The shift is accompanied by an increase in corpus atrophy. H. pylori infection should be eradicated prior to long-term acid suppression with proton pump inhibitors.

• Authors: P Moayyedi, C Wason, R Peacock, A Walan, K Bardhan, A T Axon, M F Dixon
• Journal: Helicobacter (Helicobacter) Vol. 5 Issue 4 Pg. 206-14 (Dec 2000) ISSN: 1083-4389 [Print] England
• PMID: 11179985 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Anti-Ulcer Agents
• Tinidazole
• Clarithromycin
• Omeprazole

Topics

• Adolescent
• Adult
• Anti-Bacterial Agents (therapeutic use)
• Anti-Ulcer Agents (therapeutic use)
• Clarithromycin (therapeutic use)
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Gastric Mucosa (microbiology, pathology)
• Gastritis (drug therapy, microbiology, pathology)
• Gastroesophageal Reflux (drug therapy)
• Helicobacter Infections (drug therapy, microbiology)
• Helicobacter pylori (growth & development)
• Humans
• Hydrogen-Ion Concentration
• Male
• Middle Aged
• Omeprazole (therapeutic use)
• Prospective Studies
• Tinidazole (therapeutic use)