Short-term eradication therapy for Helicobacter pylori does not reduce the incidence of gastric metaplasia in duodenal ulcer patients.
The presence of gastric metaplasia in the duodenal mucosa and Helicobacter pylori infection play an important role in the development of duodenal ulcers and the risk for ulcer relapses. The purpose of the present study was to identify the presence of gastric metaplasia in the duodenum and observation of changes in its extent during eradication therapy for Helicobacter pylori. The study population consisted of 40 patients, 15 women (aged from 29 to 65 years) and 25 men (aged from 22 to 62 years). At baseline and after 6 weeks all patients underwent endoscopic examinations of the upper alimentary tract during which two gastric antral and duodenal biopsies were obtained. The first endoscopy revealed the presence of duodenal ulcers in 22 patients, no ulcers in 11 cases, and postulceration scar in the duodenal bulb in 7 cases. The specimens were stained with hematoxylin and eosin, Giemsa and periodic acid Schiff/Alcian Blue. On first examination Helicobacter pylori infection in gastric antral specimens was detected in 40 patients. Therapy with amoxycillin, metronidazole, ventrisol and omeprazole for two weeks was administered in patients without duodenal ulcers and with omeprazole and ventrisol for additional 14 days in patients with duodenal ulcers. After therapy the presence of Helicobacter pylori was found in 10 cases, thus the degree of Hp eradication in the present study was 75%. Gastric metaplasia in duodenal samples was seen in 15 patients with duodenal ulcers and in 10 nonulcer patients. After therapy only in 4 cases gastric metaplasia was reduced along with Hp eradication, whereas in 9 cases gastric metaplasia in the duodenum was still present despite effective Hp eradication. The present findings indicate that gastric metaplasia is a reversible lesion, although this process is not dynamic and requires more time. The presence of gastric metaplasia in the duodenum after Hp eradication indicates an increased risk for the recurrence of duodenal ulcers, thus providing a useful information for a clinician.
Rudnicka
L
L
Department of Clinical and Experimental Pathomorphology, Jagiellonian University Medical College, Kraków.
Bobrzyński
A
A
Stachura
J
J
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000188:drug therapy / Q000473:pathology; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use; D013270:Stomach / Q000187:drug effects / Q000382:microbiology / Q000473:pathology*
D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D008795:Metronidazole; D000658:Amoxicillin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole