LONG-TERM SYMPTOM PATTERNS, ENDOSCOPIC FINDINGS, AND GASTRIC HISTOLOGY IN HELICOBACTER-PYLORI-INFECTED AND HELICOBACTER-PYLORI-UNINFECTED PATIENTS

There is a paucity of data on the long-term behavior of dyspepsia, end oscopic findings, and gastroduodenal histology in patients with or wit hout Helicobacter pylori colonization. We evaluated these parameters d uring a period of 7 to 19 years (average, 12.3 years) by baseline and follow-up studies. In 36 patients studied, the pattern of gastroduoden al dyspepsia and esophagogastroduodenoscopy findings remained essentia lly unchanged in 67%, and 56% respectively. Dyspepsia pat terns did no t correlate significantly with either endoscopic or histologic finding s, including the severity or location of gastritis in the fundus or an trum, or the presence or absence of H. pylori gastritis. Of 36 patient s with adequate biopsies of the fundus and antrum, H. pylori colonizat ion with gastritis was present in 73% but not in 27%. Progression to v arious degrees of atrophic gastritis was noted in 100% with, and in no ne without, H. pylori gastritis. In the fundus, atrophy progressed fro m 14% to 56%, but intestinal metaplasia did not change. In the antrum, atrophy increased from 22% to 64% and intestinal metaplasia increased from 17% to 36%. No patient demonstrated dysplasia, but severe atroph y was seen in the fundus (6%) and antrum (11%). Only two patients (5%) had severe loss of glandular elements and very low pepsinogen I, and thus can be considered to have developed advanced gastric atrophy.