Twelve-month endoscopic and histological analysis following proton-pump inhibitor-based triple therapy in Helicobacter pylori-positive patients with gastric ulcers.
OBJECTIVE
To evaluate endoscopic and histological findings after Helicobacter pylori eradication therapy in gastric ulcer (GU) patients after 12 months' follow-up.


METHODS
A total of 401 GU patients were randomized to receive either twice-daily (b.i.d.) esomeprazole 20 mg+amoxicillin 1000 mg+clarithromycin 500 mg (EAC) for 1 week followed by placebo for 3 weeks, EAC followed by once-daily (o.d.) esomeprazole 20 mg for 3 weeks or esomeprazole 20 mg b.i.d. plus placebo antibiotics for 1 week followed by esomeprazole 20 mg o.d. for 3 weeks. Endoscopy with biopsy was performed at baseline, after treatment and at 6 and 12 months' follow-up (healed patients).


RESULTS
Endoscopic abnormalities, particularly in the stomach, were common at baseline and remained similar during follow-up, regardless of ulcer status and treatment. Helicobacter gastritis was present (antrum or corpus) in approximately 20% of patients following eradication therapy (versus approximately 80% with esomeprazole alone); these effects were sustained during follow-up. Similar trends were observed for other histological variables (granulocyte and lymphoplasmocytic cell infiltration, replacement of gastric surface cells by regenerative epithelium, and mucous depletion). No changes in atrophy or intestinal metaplasia were observed. Eighteen gastric cancer cases were detected: 11 at baseline endoscopy, and seven during treatment and follow-up.


CONCLUSIONS
Endoscopic abnormalities are common in GU patients and persist after proton-pump inhibitor-based triple therapy for H. pylori eradication, which is associated with large, sustained improvements in histological variables. Follow-up endoscopy and histology may be necessary, even in patients with apparently non-malignant GU, to improve the detection rate of gastric malignancy in populations with a high prevalence of gastric cancer.
2nd Medical Clinic, Semmelweis University, Budapest, Hungary. tulassay@bel2.sote.hu
Zsolt
Z
Tulassay
Manfred
M
Stolte
Lars
L
Engstrand
Eugeniusz
E
Butruk
Peter
P
Malfertheiner
Petr
P
Dítê
Konstantin
K
Tchernev
Benjamin C Y
BC
Wong
Mattis
M
Gottlow
Stefan
S
Eklund
Michael
M
Wrangstadh
László
L
Herszényi
Péter
P
Nagy
D000658:Amoxicillin / Q000494:pharmacology / Q000627:therapeutic use; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use; D064098:Esomeprazole / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D013276:Stomach Ulcer / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D000658:Amoxicillin; D017291:Clarithromycin; D064098:Esomeprazole