Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia.
Profound suppression of gastric acid is associated with increased severity of H. pylori gastritis.
In this study, a team of doctors investigated whether H. pylori eradication influences gastritis during long-term omeprazole therapy for gastroesophageal reflux disease (GERD).
The team evaluated 231 H. pylori-positive GERD patients who had been treated for 12 months with omeprazole maintenance therapy (OM).
Patients were randomized to receive OM only, or OM plus a 1 week course of omeprazole, amoxycillin, and clarithromycin (OM triple).
The team performed endoscopy with standardized biopsy sampling and symptom evaluation at baseline, and after 1 and 2 years.
They assessed gastritis was assessed according to the Sydney classification.
|H. pylori eradication did not alter the dose of omeprazole required.|
The doctors found that corpus gastritis activity at entry was moderate or severe in 50% of the OM only group, and 55% of the OM triple group.
In the OM triple group, H. pylori was eradicated in 88% patients. Activity and inflammation decreased substantially in both the antrum and corpus.
The team determined that atrophic gastritis also improved in the corpus, but not in the antrum.
In the OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy. The team found that inflammation increased in these patients.
H. pylori eradication did not alter the dose of omeprazole required, or reflux symptoms.
Dr Kuipers's team concluded, "Most H. pylori-positive GERD patients have a corpus predominant pangastritis during omeprazole maintenance therapy".
"Eradication of H. pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy".
"H. pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose".
"We therefore recommend eradication of H. pylori in GERD patients receiving long term acid suppression".