Peptic ulcer occurrence in follow-up of chronic gastritis in patients withtreated and not eradicated CagA-positive Helicobacter pylori infection

The aim of the present prospective investigation was to study 49 dyspeptic Helicobacter pylori (HP)-positive (HP+) or -negative (HP-), CagA(+) and Cag A(-) patients with a normal pattern or pure chronic gastritis at initial hi stology as well as normal features or hyperemic gastropathy at initial endo scopy in a two-year follow up. All the HP+ patients were treated with omepr azole 20 mg twice a day plus amoxicillin 1 g twice a day for two weeks. No substantial change was seen in gastritis in CagA(+) patients in whom the in fection was not eradicated, and, in contrast, a progressive improvement in 13/14 successfully treated patients was found. At endoscopy, a progressive change to a normal picture was seen in 8 and no change in 6 of 14 patients whose HP infection was eradicated, in contrast a worsening in the 9 HP+ pat ients who were still infected was observed. In particular, peptic lesions a rose in 6 of 21 CagA(+) patients in whom the infection was not eradicated. In conclusions, the lack of change in chronic gastritis at histology and th e progressive worsening of endoscopic hyperemic gastropathy (with peptic le sions arising in 28.6%) when HP+ CagA(+) infection is not eradicated, unlik e the progressive improvement of the anatomoclinical condition in the patie nts whose infection was eradicated, draws attention to the relevance of era dicating HP in CagA(+) patients even when no peptic lesion is found at init ial endoscopy.