Atrophy and intestinal metaplasia one year after cure of H-pylori infection: A prospective, randomized study

Background & Aims: Helicobacter pylori-infected gastric mucosa evolves thro ugh stages of chronic gastritis, intestinal metaplasia (IM), glandular atro phy (GA), and dysplasia before carcinoma develops. We studied if H. pylori eradication would alter the course of premalignant histologic changes in th e stomach. Methods: Volunteers from the Yantai County in China underwent up per endoscopy with biopsy specimens obtained from the antrum and corpus. H. pylori-infected subjects were randomized to receive either a 1-week course of omeprazole, amoxicillin, and clarithromycin (OAC) or placebo. At 1 year , endoscopies with biopsies were repeated. Results: A total of 587 H. pylor i-infected subjects were randomized to OAC (n = 295) and placebo (n = 292), At 1 year, H, pylori was eradicated in 226 subjects assigned to OAC. In th e placebo group, 245 patients remained H. pylori infected. Analysis of pair ed samples obtained from the same patients showed that acute and chronic ga stritis decreased in both the antrum and corpus after H. pylori eradication (P < 0.001) and activity of IM decreased in antrum (P = 0.014). In the H, pylori-infected group, antral biopsy specimens had more pronounced acute ga stritis (P = 0.01), whereas corpus specimens showed increased acute and chr onic gastritis (P < 0.001) and a marginal increase in GA (P = 0.052). When histologic changes were compared between the 2 groups, decrease in acute an d chronic gastritis was more frequent after H. pylori eradication (P < 0.00 1) but changes in IM were similar. In the H. pylori-infected group, increas e in GB was seen in the corpus IP = 0.01). Conclusions: At 1 year, H. pylor i eradication is beneficial in preventing progression of pathologic changes of the gastric mucosa.