LONG-TERM EFFECT OF HELICOBACTER-PYLORI ERADICATION ON GASTRIC METAPLASIA IN PATIENTS WITH DUODENAL-ULCER

There have been conflicting reports on the effect of Helicobactor pylo ri eradication on gastric metaplasia in the duodenal bulb (DGM). In th e present study, we have investigated the relationships between DGM an d H. pylori by examining whether or not H. pylori-positive patients ha d more DGM than H. pylori-negative patients with nonulcer dyspepsia (N UD) or duodenal ulcer (DU), and by examining the effect of eradication of H. pylori on the prevalence and the extent of DGM during the long- term up to 4 years. Fifty H. pylori-positive and seven H. pylori-negat ive patients with DU and 23 H. pylori-positive and 23 H. pylori-negati ve NUD subjects were studied. Two duodenal bulb biopsy specimens were taken for histologic evaluation and the presence and the extent of DGM were evaluated. The extent of DGM was classified as none (grade 0), f ocal (grade 1), multifocal (grade 2), and diffuse type (grade 4). In H . pylori-positive patients with DU, follow-up gastroscopy was conducte d 4 weeks, 1 year, and 4 years after H. pylori eradication. DGM was si gnificantly (p < 0.001) more common (DU: 93%, NUD: 22%) and significan tly (p < 0.001) greater in extent for patients with DU than for NUD su bjects (DU: 1.89, NUD: 0.28). Neither the prevalence nor the extent of DGM was affected by H. pylori status in patients with DU or NUD: the prevalence (extent) of DCM of H. pylori-positive and -negative patient s with DU were 96% (1.94) and 71% (1.57), respectively. In the 43 ''H. pylori-eradicated'' group, initial prevalence of DGM was 95% and thos e of 4 weeks, 1 year, and 4 years after eradication were 91%, 96%, and 79%, respectively The initial extent of DGM was 1.93, and those of 4 weeks, 1 year, and 4 years after eradication were 1.90, 1.88, and 1.57 , respectively. In conclusion, the prevalence and the extent of DGM we re not related to H, pylori in patients with DU or NUD. In addition, t he prevalence and the extent of DGM did not change until 1 year after H. pylori eradication in patients with DU, and decreased to the initia l level of the H. pylori-negative DU group but without statistical sig nificance after 4-year follow-up.