Does acid suppression by antacids and H2 receptor antagonists increase theincidence of atrophic gastritis in patients with or without H-pylori gastritis?

Currently there is controversial evidence that suggests that the accepted i ncidence of atrophic gastritis of 1.2 to 3.3% in patients with Helicobacter pylori gastritis may be increased by the long-term suppression of acid by a proton pump inhibitor (omeprazole). The purpose of this study is to show whether lesser forms of acid suppression by antacids or H2 receptor antagon ists may have an influence on the development of atrophic gastritis. The au thors recently reported a study in which a cohort of 36 patients with sympt oms of dyspepsia were followed clinically for a period of 7 to 19 years. In that report all subjects underwent upper endoscopy with two biopsy specime ns each from the antrum and fundus, on at least two occasions, 7 to 19 year s apart. A diagnosis of atrophic gastritis was based on the interpretation of these biopsies by two gastrointestinal pathologists. The presence of H. pylori colonization was determined by tissue sampling and by a campylobacte r-like organisms test of the antrum. Of the 36 patients in the authors' pre vious report, 33 had adequate baseline and follow-up data on medications co nsumed throughout the period of the study. In their current report they now present the findings of a retrospective review in which they correlate the presence of atrophic gastritis with the sole use of antacids and H2 recept or antagonists throughout the period of the study. In the cohort of 33 pati ents evaluated from the previous report, the authors found that atrophic,ga stritis had developed in all 28 patients positive for H, pylori, and in non e of the 5 patients negative for H. pylori (p < 0.0001). A retrospective an alysis of this previously studied cohort of 33 patients revealed that the u se of antacids and H2 receptor antagonists did not predict the development of atrophic gastritis in either H. pylori-negative or -positive subjects. I n a retrospective analysis of a cohort of 33 patients followed for an avera ge of 11.7 years, atrophic gastritis developed in H, pylori-positive but no t in H. pylori-negative subjects, irrespective of the use and duration of a ntacids or H2 receptor antagonists.