Eradication of Helicobacter pylori in follicular and nonfollicular gastritis

Effective eradication therapy of Helicobacter pylori (Hp) in non-follicular type gastritis is commonly demonstrated by many studies. In contrast, some other studies show that the eradication of Hp is low in follicular type gastritis. However, the subject concerning the comparison of the results of triple-drug Hp eradication treatment between follicular and nonfollicular type gastritis is still unclear because of the paucity of studies. The aim of this study was to compare the results of Hp eradication therapy between follicular and non-follicular type gastritis.

Two age- and sex-matched groups, consisting of 21 patients with follicular type and 23 patients with nonfollicular type gastritis associated with Hp (histopathologically diagnosed after endoscopic procedure), were enrolled into our study. Triple-drug Hp eradication therapy [lansoprazole (L) 30 mg bid, amoxicillin (A) 1000 g bid and clarithromycin (C) 500 mg bid] was given to all patients in both groups for two weeks. Control for the eradication of Hp was performed by endoscopic biopsy (3 months after treatment) in the follicular group and by urea-breath test (1 month after treatment) in the nonfollicular group. Eradication of the follicles in follicular type gastritis was also observed in the control endoscopic biopsies. For the statistical analysis, SPSS 11 for Windows was used and paired-samples t-test was performed. p<0.05 was considered as significant.

In total, 66 patients were enrolled into the study. All were histopathologically diagnosed as having Hp-associated gastritis (31 follicular and 35 nonfollicular) and started on triple-drug Hp eradication therapy. Only 44 of these patients (21 follicular gastritis and 23 nonfollicular gastritis) completed 2 weeks of treatment. The other 22 patients were not able to complete the treatment because of not taking the drugs properly or of the side-effects of the drugs. Patient compliance ratio to the treatment was 67.7%. The ratios for Hp eradication in follicular and nonfollicular type gastritis were found to be 43% and 74% respectively. Lymphoid follicles in 43% of patients with follicular gastritis disappeared after the eradication therapy.

Lymphoid follicles, which are thought to be the primary lesions of low-grade Mucosa associated lymphoid tissue (MALT) tumors, come out frequently in Hp-associated gastritis. Although the eradication of Hp is said to be difficult in the presence of lymphoid follicles, there is still limited knowledge about this situation. The ratio of effective eradication of Hp with LAC combination therapy in nonfollicular gastritis is nearly over 80%. However, in our study we observed an obvious lower Hp eradication ratio in follicular type gastritis than in nonfollicular gastritis. Thus, in order to achieve higher Hp eradication ratios in follicular gastritis, duration of the triple-drug treatment might be lengthened or bismuth salt preparations need to be added to triple combination therapies.