Prolonged use of proton pump inhibitors, CagA status, and the outcome of Helicobacter pylori gastritis.
OBJECTIVE
To assess whether prolonged use of proton pump inhibitors (PPIs) in patients infected with Helicobacter pylori has adverse effects on gastritis.


METHODS
We studied 34 H. pylori-positive individuals with reflux esophagitis, Barrett esophagus, or nonulcer dyspepsia. Half of them were on maintenance treatment with PPIs (mean, 8 years) and half were not.H. pylori and CagA status were tested serologically. Gastric biopsies were classified histopathologically by the updated Sydney classification.


RESULTS
Proton pump inhibitors in H. pylori gastritis are associated with significantly less antral inflammation and lower H. pylori density, regardless of CagA status. There was a tendency toward more antral atrophy in patients with the CagA strain who were undergoing maintenance treatment with PPIs (p = 0.08), but there was an opposite tendency in CagA-negative individuals (p = 0.08). Intestinal metaplasia was seen more frequently in CagA-positive, treated individuals (p = 0.028).


CONCLUSIONS
These findings support the hypothesis that CagA status is important in the progression to atrophy and that maintenance treatment with PPIs accelerate this progression, while reducing inflammatory infiltration.
Gudlaugsdottir
Sunna
S
Department of Internal Medicine, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
van Dekken
Hermann
H
Stijnen
Theo
T
Wilson
J H Paul
JH
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial; D001426:Bacterial Proteins / Q000378:metabolism*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000382:microbiology; D005756:Gastritis / Q000382:microbiology*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D013997:Time Factors
D000897:Anti-Ulcer Agents; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D054328:Proton Pump Inhibitors; C080866:cagA protein, Helicobacter pylori; D009853:Omeprazole