Atrophy, acid suppression and Helicobacter pylori infection: a tale of twostudies

Much of what is currently accepted regarding Helicobacter pylori-associated gastritis and its relationship with gastric adenocarcinoma rests on the as sumption that atrophic gastritis can be correctly identified and reproducib ly recognized, Several studies have indicated that pathologists have a low level of agreement on this topic, and the terms 'gastric atrophy' and 'atro phic gastritis' remain imprecisely defined and poorly understood, Furthermo re, the genesis and progression of the atrophic changes that take place in the gastric mucosa of some individuals infected with H. pylori are incomple tely characterized. The lack of a strict definition of atrophic gastritis i s at least partially responsible for recent concerns regarding the effects of prolonged pharmacological gastric acid inhibition in patients with H. py lori infection, One recent paper concluded that patients with reflux oesoph agitis and H. pylori infection who are treated with longterm acid inhibitio n have an increased risk of atrophic gastritis, As this term evokes associa tions with an increased risk of gastric cancer, the possibility was subsequ ently raised that anti-secretory maintenance therapy might increase the ris k of cancer in H, pylori-positive patients. A second report, however, concl uded that long-term acid-inhibitory therapy for an average of three years i s no different from fundoplication in the development of gastric atrophy, A lso, because no intestinal metaplasia developed in any of the patients, and only atrophic gastritis associated with intestinal metaplasia is considere d a precursor of gastric cancer, there is no evidence to support the hypoth esis that long-term acid inhibition in individuals with H. pylori infection increases the risk of gastric cancer. fur I Gastroenterol Hepatol 11 (supp l 2):S29-S33 (C) 1999 Lippincott Williams & Wilkins.