Long-term effects of Helicobacter pylori eradication on gastric antral mucosa in duodenal ulcer patients

Objectives The aim of this study was to assess the consequences of prolonge d Helicobacter pylori eradication on gastric antral mucosa in duodenal ulce r patients. Patients and methods Forty-three duodenal ulcer patients with confirmed H. pylori eradication after one year of follow-up were included in this retros pective study. Before H. pylori eradication and during the follow-up, four antral prepyloric biopsy samples were taken for histopathological examinati on and culture. Histopathological lesions were graded semi-quantitatively a ccording to the updated Sydney System for activity, chronic inflammation, g landular atrophy and intestinal metaplasia (IM), as well as presence of lym phoid follicles. Results After a mean follow-up of 43 +/- 23 months, H. pylori eradication s tatistically improved all gastritis scores, including the atrophy score and the lymphoid follicle score but excluding the IM score. H. pylori eradicat ion resulted in normalization of gastric mucosa in 51.2% of patients and a significantly lower proportion of patients with non-atrophic gastritis and atrophic gastritis without IM. Atrophy totally disappeared in 16/29 patient s (55.2%) in whom Inn was absent. No predictive factor for regression of at rophy or normalization of gastric mucosa was identified. Conclusion In duodenal ulcer patients, prolonged absence (more than one yea r) of H. pylori can lead to normalization of the antral mucosa and the disa ppearance of mucosa-associated lymphoid tissue, as well as the regression o f antral atrophy. Long-term studies involving selected patients with atroph y and IM which persist after H. pylori eradication are needed to determine the potential benefits of treating H. pylori gastritis with regard to gastr ic cancer prevention. Eur J Gastroenterol Hepatol 12:719-725 (C) 2000 Lippi ncott Williams & Wilkins.