Disappearance of Helicobacter without antibiotics in 12 patients with gastritis

Detection of Helicobacter pylori in endoscopic gastric biopsies has been associated with a variety of diseases, including ulcers and gastritis. Although the natural history of H pylori in the gastric mucosa is unknown, antibiotic regimens have been used for eradication. Gastric biopsies from 6050 endoscopic procedures done by a single gastroenterologist from 1981 to 1994 were evaluated. Of these, 2860 from April 1, 1991 to September 30, 1994 had silver-stained biopsies to facilitate H pylori detection, and at least two upper endoscopic procedures were done with gastric biopsies in 188 patients. Twelve of the 188 patients with an initially positive H pylori gastric biopsy became H pylori-negative without antibiotic treatment for H pylori or other infection, 10 received omeprazole and two received no drug treatment. In two of the 12 patients recurrent H pylori in the gastric mucosa was also documented. These findings indicate that H pylori may disappear and reappear in the gastric mucosa with no specific antibiotic eradication regimen, although omeprazole may eradicate H pylori in vivo in some patients. The natural history of H pylori in gastric biopsies is poorly understood. Improved understanding, especially regarding the pathogenesis of upper gastrointestinal ulcerative and inflammatory disease processes, is essential before recommendations for specific antibiotic eradication regimens can be made.