H. pylori eradication prevents the progression of gastric intestinal metaplasia in reflux esophagitis patients using long-term esomeprazole.
OBJECTIVE
This study aimed to determine whether Helicobacter pylori eradication limits the progression of precancerous changes, manifested as intestinal metaplasia (IM), in patients with reflux esophagitis using long-term esomeprazole.


METHODS
Three hundred twenty-five reflux esophagitis patients were enrolled and randomly assigned to (i) the H. pylori-positive eradication group receiving 1-week triple therapy (n=105); (ii) H. pylori-positive non-eradication controls (n=105); and (iii) H. pylori-negative controls (n=115). All the patients received continuous esomeprazole until sustained symptomatic response, and when possible, shifted to on-demand therapy (ODT) thereafter. Serial gastroscopy was scheduled on enrollment and at the end of the first and second years to assess the prevalence and progression or regression of gastric atrophy (AT) and IM.


RESULTS
There were 93 patients in the H. pylori-eradication group, 83 in the non-eradication controls, and 100 in the negative controls to complete the study. The negative controls had no progression of AT and IM during follow-up. For the H. pylori-positive eradication group, there was significant regression of AT and IM during follow-up (P<0.05). In the H. pylori-positive non-treated controls, the prevalence rates of AT and IM were significantly greater on the second year than on enrollment (P<0.05). During the second-year follow-up, the patients in the eradication group achieved more regression and less development of AT and IM than did the non-eradication controls (P<0.001).


CONCLUSIONS
In patients using long-term esomeprazole for reflux esophagitis, screening for and eradicating H. pylori infection are necessary in order to limit the progression or cause the regression of gastric precancerous changes.
Department of Pathology, National Cheng Kung University Medical Center, Tainan, Taiwan, Republic of China.
Hsiao-Bai
HB
Yang
Bor-Shyang
BS
Sheu
Shin-Tar
ST
Wang
Hsiu-Chi
HC
Cheng
Wei-Lun
WL
Chang
Wei-Ying
WY
Chen
D000328:Adult; D000704:Analysis of Variance; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D016001:Confidence Intervals; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D064098:Esomeprazole / Q000008:administration & dosage*; D004942:Esophagitis, Peptic / Q000150:complications*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D007414:Intestinal Neoplasms / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D008134:Long-Term Care; D008297:Male; D008679:Metaplasia / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D011336:Probability; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D064098:Esomeprazole