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Helicobacter pylori eradication and antral intestinal metaplasia--two years follow-up study
J Ciok1, J Dzieniszewski, C Lucer
1Department of Metabolic Diseases and Gastroenterology, National Food and Nutrition Institute, Warsaw.
Abstract:
Intestinal metaplasia (IM) appears to be an important stage in the pathogenesis of intestinal type of gastric cancer. The purpose of the study was to evaluate how H. pylori eradication modifies IM in gastric antrum. 35 patients (19 M + 16 F) with peptic ulcer (28 duodenal ulcer +7 gastric ulcer) and antral IM with accompanying H. pylori infection proven by urease test and histological examination were followed-up after healing an ulcer achieved by 14 days treatment with 40 mg/d omeprazole and 2 g/d amoxicillin. Endoscopy examination was done every 4 months during 2 years after eradication. At least two antral biopsies were taken during each endoscopy. H. pylori eradication was achieved in 23 patients (66%). No reinfection was observed during the time of observation. The medium grade of intestinal metaplasia after eradication of H. pylori declined from 1.76 to 0.57 over the period of follow-up (p < 0.01). The difference became statistically significant from the 12 months after eradication. No significant change was seen in the group of non-eradicators (1.83 at the beginning of observation and 1.91 at the end point). Statistical difference between eradicators and non-eradicators was stated from the 12th month after eradication. Total regression of intestinal metaplasia was observed in 30% cases after one year and 61% cases after two years after H. pylori eradication. The cure of H. pylori infection significantly reduces the presence of antral IM. Regression of IM appears to be a long-term process taking many months after H. pylori eradication.
Insights
Eradicating Helicobacter pylori (H. pylori) infection significantly reduces intestinal metaplasia (IM) in the gastric antrum. This regression of IM is a gradual process, with significant improvements observed over two years post-eradication.
Area of Science:
- Gastroenterology
- Oncology
- Microbiology
Background:
- Intestinal metaplasia (IM) is a precursor to gastric cancer.
- Helicobacter pylori (H. pylori) infection is linked to IM development.
- Understanding IM modification by H. pylori eradication is crucial for gastric cancer prevention.
Purpose of the Study:
- To investigate the impact of H. pylori eradication on intestinal metaplasia (IM) in the gastric antrum.
- To assess the rate and extent of IM regression following successful H. pylori treatment.
Main Methods:
- 35 patients with peptic ulcers, antral IM, and H. pylori infection underwent eradication therapy (omeprazole + amoxicillin).
- Follow-up included endoscopy and biopsies every 4 months for 2 years post-treatment.
- H. pylori status and IM grade were assessed via urease tests, histology, and endoscopic biopsies.
Main Results:
- H. pylori eradication was successful in 66% of patients.
- A significant decline in the mean grade of intestinal metaplasia was observed in eradicators (from 1.76 to 0.57, p < 0.01).
- Complete IM regression occurred in 30% after 1 year and 61% after 2 years; non-eradicators showed no significant change.
Conclusions:
- H. pylori eradication effectively reduces the severity of gastric antral intestinal metaplasia.
- Regression of intestinal metaplasia is a prolonged process, becoming statistically significant 12 months after H. pylori eradication.
- Successful H. pylori treatment is a key factor in managing precancerous lesions like IM.