Sustained epithelial proliferation in a functionally irreversible fundic mucosa after Helicobacter pylori eradication.
BACKGROUND
We recently reported the expansion of the acid-secreting mucosa following Helicobacter pylori eradication with Congo red chromoendoscopy for a short-term follow-up of up to 7 months. We aimed to extend the observation period and to clarify the characteristic features of acid-secreting and non-acid-secreting mucosa.


METHODS
In 24 H. pylori-positive patients with fundic atrophy, Congo red chromoendoscopy was performed prior to, 1 month, 7 months, and finally more than 2 years after the eradication. The areas of the acid-secreting mucosa were evaluated semiquantitatively. Two gastric biopsy specimens were taken from the acid-secreting and non-acid-secreting areas at the final chromoendoscopy and were subjected to histologic evaluation and immunohistochemistry for Ki-67 as a proliferation index.


RESULTS
After a gradual increase in acid-secreting areas for up to 7 months after eradication, they further increased in 79% subjects between 7 months and the final observation at a mean follow-up of 62 months. However, there still existed non-acid-secreting mucosa in the fundic area in all subjects, indicating that the expansion of acid-secreting mucosa remained partial. Compared with the neighboring acid-secreting area, the non-acid-secreting area was characterized histologically by higher degrees of residual inflammation, mucosal atrophy, and intestinal metaplasia, and by sustained hyperproliferation as well.


CONCLUSIONS
Functionally irreversible (non-acid-secreting) gastric mucosa after eradication was associated with extensive intestinal metaplasia and sustained hyperproliferation, suggesting that such mucosa still possesses malignant potential. Congo red chromoendoscopy may be useful for estimating the risk of subsequent development of gastric cancer following successful H. pylori eradication by determining the distribution of functionally irreversible mucosa.
Iijima
Katsunori
K
Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
Koike
Tomoyuki
T
Sekine
Hitoshi
H
Abe
Yasuhiko
Y
Asanuma
Kiyotaka
K
Ara
Nobuyuki
N
Uno
Kaname
K
Imatani
Akira
A
Ohara
Shuichi
S
Shimosegawa
Tooru
T
D049109:Cell Proliferation; D004396:Coloring Agents; D003224:Congo Red; D004847:Epithelial Cells / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005744:Gastric Acid / Q000378:metabolism; D005748:Gastric Fundus / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D005753:Gastric Mucosa / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors
D004396:Coloring Agents; D003224:Congo Red