Distribution of atrophy in Helicobacter pylori-infected subjects taking proton pump inhibitors

Background: Gastric atrophy is associated with Helicobacter pylori infectio n. Conflicting results have been obtained as to whether acid suppressant th erapy hastens the development or changes the distribution of atrophy in the stomach. The aim of this study was to investigate whether concomitant prot on pump inhibitor (PPI) therapy in H. pylori-infected individuals resulted in an increase or an alteration in atrophy distribution and whether this wa s reflected by the plasma gastrin. Methods: Multiple gastric biopsy specime ns were taken from the antrum and corpus from 46 H. pylori-infected subject s, 18 of whom were taking PPIs, and assessed histologically by the updated Sydney System. The control group was age- and sex-matched to the index grou p. Fasting gastrin levels were measured. Results: In the control group ther e was no significant tendency for either antral or corpus atrophy to predom inate (P = 0.44). In the treatment group there was a significant tendency f or corpus as opposed to antral atrophy to develop (P < 0.001). There was no significant difference in the overall atrophy score between the treated an d untreated groups (P = 0.76). Fasting gastrin levels were significantly hi gher in the treated group (P < 0.001). Conclusions: Treatment with PPIs in H. pylori-infected subjects does not lead to an overall increase in gastric atrophy, it does, however, result in an increased prevalence of corpus as opposed to antral atrophy. This is associated with a significantly higher g astrin level.