A team from the UK and Sweden investigated the hypothesis that long-term acid suppression would result in relatively greater Helicobacter pylori colonization in the corpus, leading to diffuse or corpus-predominant gastritis. This would be prevented by prior H. pylori eradication.
The team conducted a prospective, double-blind trial of the effect of 12-month maintenance treatment with omeprazole, in H. pylori-positive GERD patients, on gastric histology. The patients were randomly assigned to either an eradication or omeprazole-alone regimen.
A control group of 20 H. pylori-negative GERD patients also received omeprazole throughout the study period.
Biopsies were taken at baseline and at 12 months. The 41 H. pylori-positive subjects with esophagitis were randomly assigned (20 to omeprazole alone, 21 to eradication) and 33 subjects completed the 12-month study.
The researchers found that there was a significant decline in antral chronic inflammation in initially positive patients, between baseline and end, in both the eradication group and the omeprazole-alone group. However, corpus chronic inflammation increased in the omeprazole-alone group, but decreased in the eradication group.
Development of mild corpus atrophy after PPI treatment:
H. pylori eradication 0/8
The change toward corpus predominance, between baseline and end, was highly significant for the omeprazole-alone group. Furthermore, 5 of 11 in the omeprazole-alone group developed mild corpus atrophy, compared to 0 of 8 who had undergone H. pylori eradication. The change in frequency of corpus atrophy between the two groups was also significant.
Researcher Paul Moayyedi said on behalf of the group, "In H. pylori-positive subjects with GERD, long-term acid suppression leads to a shift from antral- to corpus-predominant gastritis that can be prevented by prior eradication. The shift is accompanied by an increase in corpus atrophy."
"H. pylori infection should be eradicated prior to long-term acid suppression with proton pump inhibitors," he concluded.