title: Severe gastritis decreases success rate of Helicobacter pylori eradication.
abstract: BACKGROUND
  In several studies, different risk factors other than antibiotic resistance have been documented with Helicobacter pylori eradication failure. We aimed in this study to investigate the relationship of gastric density of H. pylori, the occurrence/degree of gastric atrophy, and intestinal metaplasia (IM) with success rate of H. pylori eradication.
  
  
  METHODS
  Two hundred consecutive treatment naive patients who received bismuth containing standart quadruple treatment due to H. pylori infection documented by histopathological examination of two antral or two corpal biopsies entered this retrospective study. The updated Sydney system was used to grade the activity of gastritis, density of H. pylori colonization, atrophy, and IM. Stages III and IV of operative link for gastritis assessment (OLGA) or the operative link on gastric intestinal metaplasia assessment (OLGIM) stages was considered as severe gastritis. H. pylori eradication was determined via stool H. pylori antigen test performed 4 weeks after the end of therapy.
  
  
  RESULTS
  The presence of gastric atrophy and IM was significantly higher in patients with eradication failure (p = 0.001 and 0.01, respectively). Severe gastritis (OLGA III-IV and OLGIM III-IV) rates were higher in eradication failure group. A multiple linear regression analysis showed that OLGA and OLGIM stages were to be independent risk factors for eradication failure (p = 0.03 and 0.01, respectively).
  
  
  CONCLUSIONS
  Our results suggested that histopathologically severe gastritis may cause H. pylori eradication failure. In addition, we found that H. pylori density was not a risk factor for treatment failure in patients who receive quadruple treatment.
authors.affiliation: Department of Gastroenterology, Kırıkkale University Faculty of Medicine, Attar Sokak 21/14 G.O.P., Çankaya, 06700, Ankara, Turkey. drismailster@gmail.com.
authors.forename: Ismail Hakki
authors.initials: IH
authors.lastname: Kalkan
authors.affiliation: Department of Gastroenterology, Kırıkkale University Faculty of Medicine, Attar Sokak 21/14 G.O.P., Çankaya, 06700, Ankara, Turkey.
authors.forename: Ferdane
authors.initials: F
authors.lastname: Sapmaz
authors.affiliation: Department of Gastroenterology, Kırıkkale University Faculty of Medicine, Attar Sokak 21/14 G.O.P., Çankaya, 06700, Ankara, Turkey.
authors.forename: Sefa
authors.initials: S
authors.lastname: Güliter
authors.affiliation: Department of Pathology, Kırıkkale University Faculty of Medicine, Ankara, Turkey.
authors.forename: Pınar
authors.initials: P
authors.lastname: Atasoy
mesh_terms: D000328:Adult; D058491:Bacterial Load / Q000706:statistics & numerical data*; D005260:Female; D005756:Gastritis / Q000188:drug therapy* / Q000453:epidemiology*; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
keywords: Atrophy; H. pylori; Intestinal metaplasia; OLGA; OLGIM; Sydney