The effect of eradicating Helicobacter pylori infection on the course of adenomatous and hyperplastic gastric polyps

Objective Histopathological and clinical data strongly suggest that Helicob acter pylori is the cause of chronic gastritis and peptic ulceration. Howev er, little has been written about the potential causal relation of H. pylor i infection to hyperplastic and adenomatous gastric polyps. We therefore ca rried out a prospective study to determine the effect of eradicating H. pyl ori infection on the course of hyperplastic and adenomatous gastric polyps. Methods From November 1996 to December 1997, 6700 patients who had undergon e upper gastrointestinal endoscopy at the two centres in Zagreb, Croatia, w ere candidates for participation in the study. Hyperplastic and adenomatous polyps were diagnosed on a basis of at least three histological samples ta ken from the polyp. In seven patients endoscopy had to be repeated because forceps biopsy sampling either provided inadequate tissue for correct histo logical diagnosis, or accurate characterization of gastric polyp histology was not possible. Upon completion of all endoscopic examinations before and after treatment, biopsy samples were taken from the antrum (two) and the b ody of the stomach (two) so that gastritis could be graded and classified, and the presence of H. pylori sought by histology. Two other samples were t aken from the antrum for a rapid urease test Follow-up examinations were pe rformed by using endoscopy. Control endoscopy was performed at least 4 week s after the treatment of H. pylori infection had been completed, and then e very 3-4 months. The follow-up ranged from 4 to 17 months, with a median of 14 months. The treatment of H. pylori infection consisted of a 1-week cour se of either omeprazole (20 mg twice daily) or pantoprazole 40 mg twice dai ly), and a 1-week course of amoxicillin 2 g twice daily) and metronidazole (400 mg three times daily), and clarithromycin (500 mg twice daily). Eradic ation of H. pylori infection was assessed by repeated histology and rapid u rease test. Results Twenty-one patients (nine women, 12 men; median age 52 years) with histologically proven hyperplastic gastric polyps, and seven patients (two women, five men; median age, 67 years) with adenomatous gastric polyps were included in the study. Among 21 patients with hyperplastic gastric polyps, 16 patients (76%) were positive for H. pylori infection. Only two patients (29%) with adenomatous gastric polyps were positive for the infection. Com plete eradication of H. pylori was initially achieved in all patients posit ive for H. pylori. Total regression of the gastric polyps was observed only among the patients with hyperplastic gastric polyps in whom H. pylori had been eradicated. Complete regression of the hyperplastic gastric polyps was observed in seven of the 16 evaluable patients (44%; 95% CI, 19-68%) after H. pylori eradication. The endoscopic snare polypectomy was carried out in nine patients with hyperplastic polyps and two patients with adenomatous g astric polyps in whom regression of the polyps was not observed after H, py lori eradication, as well as in five patients with hyperplastic and four wi th adenomatous gastric polyps who were negative for H. pylori. Exploratory laparotomy and gastrotomy with polyps excision were carried out in one pati ent with multiple adenomatous gastric polyps. In only one patient who was n ot positive for H. pylori recurrence of hyperplastic gastric polyp was reco rded during follow-up, and no re-infection with H. pylori has been detected . Conclusions Our results suggest that the development of hyperplastic gastri c polyps may be directly related to chronic active gastritis and concomitan t H. pylori infection. Cure of H. pylori infection associated with hyperpla stic gastric polyps resulted in complete polyp regression in more than 40% of patients. Therefore, for patients with hyperplastic gastric polyps and c oncurrent H. pylori infection an antibiotic treatment designed to eradicate H. pylori appears to be recommended before further therapeutic options are considered. for J Gastroenterol Hepatol 11:727-730 (C) 1999 Lippincott Wil liams & Wilkins.