title: Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication.
abstract: BACKGROUND
  Helicobacter pylori infection plays an important part in the development of atrophic gastritis and intestinal metaplasia, conditions that predispose patients gastric cancer. Profound suppression of gastric acid is associated with increased severity of gastritis caused by H. pylori, but it is not known whether acid suppression increases the risk of atrophic gastritis.
  
  
  METHODS
  We studied patients from two separate cohorts who were being treated for reflux esophagitis: 72 patients treated with fundoplication in Sweden and 105 treated with omeprazole (20 to 40 mg once daily) in the Netherlands. In both cohorts, the patients were followed for an average of five years (range, three to eight). After fundoplication, the patients did not receive acid-suppressive therapy. The presence of H. pylori was assessed at the first visit by histologic evaluation in the fundoplication group and by histologic and serologic evaluation in the omeprazole group. The patients were not treated for H. pylori infection. Before treatment and during follow-up, the patients underwent repeated gastroscopy, with biopsy sampling for histologic evaluation.
  
  
  RESULTS
  Among the patients treated with fundoplication, atrophic gastritis did not develop in any of the 31 who were infected with H. pylori at base line or the 41 who were not infected; 1 patient infected with H. pylori had atrophic gastritis before treatment that persisted after treatment. Among the patients treated with omeprazole, none of whom had atrophic gastritis at base line, atrophic gastritis developed in 18 of the 59 infected with H. pylori(P<0.001) and 2 of the 46 who were not infected (P=0.62).
  
  
  CONCLUSIONS
  Patients with reflux esophagitis and H. pylori infection who are treated with omeprazole are at increased risk of atrophic gastritis.
authors.affiliation: Department of Gastroenterology of the Free University Hospital, Amsterdam, the Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: L
authors.initials: L
authors.lastname: Lundell
authors.forename: E C
authors.initials: EC
authors.lastname: Klinkenberg-Knol
authors.forename: N
authors.initials: N
authors.lastname: Havu
authors.forename: H P
authors.initials: HP
authors.lastname: Festen
authors.forename: B
authors.initials: B
authors.lastname: Liedman
authors.forename: C B
authors.initials: CB
authors.lastname: Lamers
authors.forename: J B
authors.initials: JB
authors.lastname: Jansen
authors.forename: J
authors.initials: J
authors.lastname: Dalenback
authors.forename: P
authors.initials: P
authors.lastname: Snel
authors.forename: G F
authors.initials: GF
authors.lastname: Nelis
authors.forename: S G
authors.initials: SG
authors.lastname: Meuwissen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D004942:Esophagitis, Peptic / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D005260:Female; D018662:Fundoplication; D005757:Gastritis, Atrophic / Q000209:etiology*; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole