Helicobacter pylori and different topographic types of gastritis: treatment response after successful eradication therapy in functional dyspepsia.
BACKGROUND
Helicobacter pylori gastritis is usually a lifelong disease which can cause different topographical inflammatory reactions and induce divergent effects on acid secretion in humans. High acid output and antrum-predominant gastritis are associated with duodenal ulcer disease, whereas corpus-predominat gastritis has been associated with low acid output and risk of gastric carcinoma. The objective of this study was to evaluate the role of different gastritis subtypes in the long-term treatment response of H. pylori-positive functional dyspepsia.


METHODS
The gastric biopsies from 143 H. pylori-positive patients with functional dyspepsia were classified in accordance with the Sydney System as antrum-predominant gastritis, pangastritis or corpus-predominant gastritis. The patients were randomized to receive either eradication therapy or placebo antibiotics. Moreover, to standardize acid suppression every patient received omeprazole therapy for the first 3 months. Dyspeptic symptoms were evaluated from a questionnaire and the follow-up time was 12 months. In addition, delta-over-baseline (DOB) values of the 13C-urea breath test (UBT) were analysed from a subgroup of 36 patients to measure urease activity of the stomach.


RESULTS
After 1 year, the dyspepsia symptom score was 7.4 +/- 3.0 (95% CI 6.6-8.2) in successfully H. pylori-eradicated patients and 7.6 +/- 3.1 (95% CI 6.9-8.4) in controls (P = ns). Among patients with antrum-predominant gastritis, dyspepsia score was reduced more in subjects whose H. pylori was eradicated than in controls with ongoing infection (-3.6 +/- 2.9 versus -1.7 +/- 2.9; P = 0.05). High urease activity of the stomach was associated with severe or moderate chronic antrum-predominant gastritis.


CONCLUSIONS
Patients with antrum-predominant H. pylori-positive chronic gastritis and functional dyspepsia get symptom improvement after successful eradication therapy. A high DOB value of UBT is associated with these patients.
Dept of Medicine, Helsinki University Central Hospital, Helsinki, Finland. Jari.koskenpato@hus.fi
J
J
Koskenpato
M
M
Färkkilä
P
P
Sipponen
D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001706:Biopsy; D001944:Breath Tests / Q000379:methods; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology* / Q000473:pathology; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D014510:Urease
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D000658:Amoxicillin; D014510:Urease; D009853:Omeprazole