EFFECTS OF ERADICATION OF HELICOBACTER-PYLORI ON GASTRITIS IN DUODENAL-ULCER PATIENTS

The incidence and mean score of Helicobacter pylori-related, active an troduodenitis, lesions of superficial antral epithelium and duodenal g astric-type metaplasia were higher in endoscopic biopsies from a large series of patients with duodenal ulcer, when compared with asymptomat ic patients or patients with nonulcer dyspepsia. In 65 out of 73 patie nts with duodenal ulcer who could be followed up, H. pylori was eradic ated using a combination of amoxycillin, 3 g daily, metronidazole, 1 g daily, and omeprazole, 20 mg daily. Rapid and permanent (6-month foll ow-up) abolition of both gastroduodenitis activity and lesions of the gastric surface epithelium was observed in these 65 patients. There wa s also a progressive decrease in total immune-inflammatory cells but w ithout a substantial change in duodenal gastric-type metaplasia. Simil ar, but transient and quantitatively less prominent, improvements were observed in the antroduodenal mucosa, which had been temporarily clea red of H. pylori by treatment with omeprazole alone. Conversely, incre ased gastritis activity, epithelial lesions and immune-inflammatory ce ll scores were found in the short term in the corpus mucosa, which was not cleared of H. pylori after omeprazole treatment. It is concluded that, of the various H. pylori-related mucosal changes, antroduodeniti s activity and antral epithelial lesions most closely reflect the seve rity of mucosal damage and are probably the most important factors in duodenal ulcerogenesis. Their complete and rapid suppression after bac terial eradication may be a key factor in preventing ulcer relapse.