Effect of Helicobacter pylori eradication on chronic gastritis during omeprazole therapy

Background-We have previously observed that profound acid suppressive thera py in Helicobacter pylori positive patients with gastro-oesophageal reflux disease is associated with increased corpus inflammation and accelerated de velopment of atrophic gastritis. Aim-To investigate if H pylori eradication at the start of acid suppressive therapy prevents the development of these histological changes. Patients/methods-In a prospective randomised case control study, patients w ith reflux oesophagitis were treated with omeprazole 40 mg once daily for 1 2 months. H pylori positive patients were randomised to additional double b lind treatment with omeprazole 20 mg, amoxicillin 1000 mg and clarithromyci n 500 mg twice daily or placebo for one week. Biopsy sampling for histology , scored according to the updated Sydney classification, and culture were p erformed at baseline, and at three and 12 months. Results-In the persistently H pylori positive group (n=24), active inflamma tion increased in the corpus and decreased in the antrum during therapy (p= 0.032 and p=0.002, respectively). In contrast, in the H pylori positive gro up that became H pylori negative as a result of treatment (n=33), active an d chronic inflammation in both the corpus and antrum decreased (p less than or equal to 0.0001). The decrease in active and chronic inflammation in th e corpus differed significantly compared with the persistently H pylori pos itive group (both p=0.001). For atrophy scores, no significant differences were observed between H pylori eradicated and persistently H pylori positiv e patients within one year of follow up. No changes were observed in the H pylori negative control group (n=26). Conclusions-H pylori eradication prevents the increase in corpus gastritis associated with profound acid suppressive therapy. Longer follow up is need ed to determine if H pylori eradication prevents the development of atrophi c gastritis.