HELICOBACTER-PYLORI INFESTATION IN GASTRIC-ULCER DISEASE - FOLLOW-UP OF PATIENTS WHO DID NOT RECEIVE ANTIMICROBIAL TREATMENT

Objective: To evaluate the influence of Helicobacter pylori-positive g astritis on the natural course of gastric ulcer disease. Patients and methods: Sixty-eight patients with endoscopically confirmed gastric ul cer disease were followed by endoscopy and biopsy for less than 6 mont hs (41 patients), 6-12 months (20 patients) or more than 12 months (38 patients; follow-up 2.6 months, range 2-108 months) after the first e ndoscopy. Stepwise biopsy specimens were taken: two from the antrum, o ne from the angulus, two from the corpus, one from the area around the ulcer, and several from the ulcer edge. Treatment of the patients com prised anticholinergics, neutralizing drugs or H-2-receptor antagonist s (cimetidine) which are known not to have significant effects on H. p ylori infestation. Results: Of the patients, 67 had gastritis at all o r some of the biopsy sites. The mean score of gastritis (inflammation and atrophy) was inversely related to the H. pylori density. The mean score of antral and corpus gastritis increased with age and length of follow-up, and was significantly higher at the first examination in th ose in whom the ulcer healed during follow-up than in those whose ulce r remained active. H. pylori density decreased during follow-up in tho se in whom the ulcer healed. However, the presence and density of H. p ylori at the first examination did not correlate clearly with the like lihood of the ulcer to heal during follow-up. After more than 2 years of follow-up, 22 of 38 patients were ulcer-free (healed); eight of the se were H. pylori-negative and 14 were H. pylori-positive at the time of the last endoscopy. Conclusions: H. pylori is involved in the natur al course of gastric ulcer disease: spontaneous resolution or absence of H. pylori infection is associated with ulcer healing; however, ulce r healing may also take place in the presence of continuing H. pylori infestation.