An 18-year follow-up study of chronic gastritis and Helicobacter pylori association of CagA positivity with development of atrophy and activity of gastritis

Background: We wanted to evaluate the course of chronic gastritis and its a ssociation with Helicobacter. pylori and CagA seropositivity in an adult sa mple from Saaremaa (Estonia) during an 18-year follow-up. Methods: Seventy persons (31 men, 39 women; median age, 57.5 years) from a primary sample of 304 subjects endoscoped in 1979 were reinvestigated by endoscopy and biops y in 1997. The state of the gastric mucosa and the presence of H. pylori in histologic sections from the antrum and corpus were assessed both in 1979 and 1997 in 66 subjects in accordance with the Sydney system, and H. pylori status in all 70 subjects was determined with the enzyme-linked immunosorb ent assay (ELISA). Anti-CagA IgGs were determined with the ELISA, using the recombinant fragment of CagA. Results. During an 18-year followup 11% of t he subjects developed atrophy in the antrum, whereas 35% developed it in th e corpus. Development of atrophy in the corpus and the appearance BE intest inal metaplasia in the antrum were associated with increased activity of ga stritis both in the initial and last follow-up biopsies. Anti-CagA positivi ty was found in 71% of H. pylori-seropositive persons (93% of subjects). Th ere was a significant association between CagA positivity and the activity of gastritis, the presence of atrophy or damage to surface epithelial cells in the antrum and in corpus mucosal biopsy specimens at the last follow-up endoscopy. Conclusion: The CagA-positive strains of H. pylori enhance the development of atrophic gastritis compared with CagA-negative strains.