Cases of reflux esophagitis developing after treatment to eradicate Helicobacter pylori have been discussed in some detail.
However, no reports are available concerning the histologic examination of reflux esophagitis both before and after eradication therapy.
Dr Nobuo Aoyama and colleagues from Japan investigated 61 patients and 111 specimens using endoscopic and histologic techniques.
The histologic findings including basal zone height, papillar height, and Ki-67 labeling index before and after treatment for H pylori assessed.
All of these markers as well as COX-2 expression were compared with those in normal controls and patients with endoscopic reflux esophagitis.
|Endoscopic reflux esophagitis occurred in 20% at 12 months after eradication therapy|
The team of doctors found that 12 months after eradication therapy, the incidence of newly developed endoscopic reflux esophagitis was 20%.
Basal zone height and papillar height had increased at 1 month, but had returned to pretreatment levels after 12 months of eradication therapy.
The doctors noted that the Ki-67 labeling index was significantly increased 1 and 12 months after eradication therapy compared to values before treatment.
COX-2 expression gradually increased after the treatment.
The team observed that the phenomena linked to esophagitis appeared after eradication therapy.
However, the severity and extent of these signs were not so high after the treatment of H pylori than in patients with overt reflux esophagitis.
Focusing on the patients with hiatal hernia, the team found that papillar height and Ki-67 labeling index increased after eradication therapy.
These values were almost the same as those in the patients with endoscopic reflux esophagitis.
Dr Aoyama's team concluded, “Hiatal hernia plays an important role in the possible occurrence of hidden reflux esophagitis after treatment for a H pylori infection.”