title: Precancerous conditions after H. pylori eradication: a randomized double blind study in first degree relatives of gastric cancer patients.
abstract: BACKGROUND
  Regression of precancerous lesions after H. pylori eradication remains controversial. This study evaluates the change and topography in first degree relatives (FDR) of gastric cancer (GC) patients following H. pylori eradication.
  
  
  METHODS
  Participants underwent endoscopy with antrum and corpus histological examinations. Subjects with pangastritis were randomly allocated to placebo or eradication therapy and followed over 4½ years.
  
  
  RESULTS
  Among 989 evaluated FDR, we excluded 468 patients as follows: 108 had macroscopic lesions, 243 had no evidence of any H. pylori infection, and 117 were excluded for other reasons. The remaining subjects (n = 521) were allocated to therapy (group A, n = 261) or placebo (group B, n = 260) groups. Interim analysis of 403 subjects (201 placebo, 202 therapy) showed regression of atrophy (60 out of 97 in the antrum and 37 out of 104 in the corpus) in H.pylori-eradicated versus regression of atrophy (57 out of 184 in the antrum and 23 out of 173 in the corpus) in non-H.pylori-eradicated cases over 2½ years (P < 0.0001). No regression of intestinal metaplasia (IM) occurred in the antrum and corpus of treated subjects over 4½ years. However, progression of IM occurred in the antrum in 17 out of 90 patients in the non-H. pylori-eradicated versus 4 out of 68 H. pylori-eradicated subjects after 4½ years (P < 0.05).
  
  
  CONCLUSIONS
  Eradication of H. pylori is associated with regression of gastric atrophy but not IM, even in its early stages. Gastric atrophy and IM in the antrum have shown more rapid progression in cases not treated for H. pylori infection (over 4½ years follow-up) compared to H. pylori-eradicated cases.
authors.affiliation: Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran. massarrat@ams.ac.ir
authors.forename: Sadegh
authors.initials: S
authors.lastname: Massarrat
authors.forename: Arghavan
authors.initials: A
authors.lastname: Haj-Sheykholeslami
authors.forename: Ashraf
authors.initials: A
authors.lastname: Mohamadkhani
authors.forename: Nasrin
authors.initials: N
authors.lastname: Zendehdel
authors.forename: Naser
authors.initials: N
authors.lastname: Rakhshani
authors.forename: Manfred
authors.initials: M
authors.lastname: Stolte
authors.forename: Mahboobeh
authors.initials: M
authors.lastname: Mirzaei
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Saliminejhad
authors.forename: Sandra
authors.initials: S
authors.lastname: Saeidi
authors.forename: Mehdi
authors.initials: M
authors.lastname: Shahidi
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia / Q000382:microbiology / Q000473:pathology*; D016009:Chi-Square Distribution; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D005757:Gastritis, Atrophic / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000382:microbiology; D011706:Pyloric Antrum / Q000382:microbiology / Q000473:pathology*; D013274:Stomach Neoplasms / Q000235:genetics / Q000382:microbiology / Q000517:prevention & control*