Long-term effects of Helicobacter pylori eradication on gastric antral mucosa in duodenal ulcer patients.
OBJECTIVE
The aim of this study was to assess the consequences of prolonged Helicobacter pylori eradication on gastric antral mucosa in duodenal ulcer patients.


METHODS
Forty-three duodenal ulcer patients with confirmed H. pylori eradication after one year of follow-up were included in this retrospective study. Before H. pylori eradication and during the follow-up, four antral prepyloric biopsy samples were taken for histopathological examination and culture. Histopathological lesions were graded semi-quantitatively according to the updated Sydney System for activity, chronic inflammation, glandular atrophy and intestinal metaplasia (IM), as well as presence of lymphoid follicles.


RESULTS
After a mean follow-up of 43 +/- 23 months, H. pylori eradication statistically improved all gastritis scores, including the atrophy score and the lymphoid follicle score but excluding the IM score. H. pylori eradication resulted in normalization of gastric mucosa in 51.2% of patients and a significantly lower proportion of patients with non-atrophic gastritis and atrophic gastritis without IM. Atrophy totally disappeared in 16/29 patients (55.2%) in whom IM was absent. No predictive factor for regression of atrophy or normalization of gastric mucosa was identified.


CONCLUSIONS
In duodenal ulcer patients, prolonged absence (more than one year) of H. pylori can lead to normalization of the antral mucosa and the disappearance of mucosa-associated lymphoid tissue, as well as the regression of antral atrophy. Long-term studies involving selected patients with atrophy and IM which persist after H. pylori eradication are needed to determine the potential benefits of treating H. pylori gastritis with regard to gastric cancer prevention.
Department of Gastroenterology, Saint-André Hospital, Bordeaux, France. frank.zerbib@chu-aquitaine.fr
F
F
Zerbib
C
C
Lenk
B
B
Sawan
R
R
Cayla
N
N
Broutet
B
B
Carles
A
A
de Mascarel
F
F
Mégraud
H
H
Lamouliatte
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D004381:Duodenal Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000187:drug effects / Q000382:microbiology; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents