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Improvement in Atrophic Gastritis and Intestinal Metaplasia in Patients in Whom Helicobacter pylori Was Eradicated

Toshifumi Ohkusa, MD; Kazuhiko Fujiki, MD; Ichizen Takashimizu, MD; Jiro Kumagai, MD; Toru Tanizawa, MD; Yoshinobu Eishi, MD; Tetsuji Yokoyama, MD; and Mamoru Watanabe, MD
[+] Article and Author Information

From School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.


Grant Support: In part by Takeda Chemical Industries, Ltd., Osaka, Japan.

Requests for Single Reprints: Toshifumi Ohkusa, MD, Department of Gastroenterology and Hepatology, School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; e-mail, ohkusa.gast@tmd.ac.jp.

Current Author Addresses: Drs. Ohkusa, Fujiki, Takashimizu, and Watanabe: Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

Drs. Kumagai, Tanizawa, and Eishi: Department of Pathology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

Dr. Yokoyama: Department of Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

Author Contributions: Conception and design: T. Ohkusa.

Analysis and interpretation of the data: T. Ohkusa, J. Kumagai, T. Tanizawa, Y. Eishi, T. Yokoyama.

Drafting of the article: T. Ohkusa.

Critical revision of the article for important intellectual content: T. Ohkusa, M. Watanabe.

Final approval of the article: T. Ohkusa, M. Watanabe.

Provision of study materials or patients: T. Ohkusa, K. Fujiki, I. Takashimizu.

Statistical expertise: T. Yokoyama.

Obtaining of funding: T. Ohkusa.

Administrative, technical, or logistic support: K. Fujiki, I. Takashimizu, J. Kumagai, T. Tanizawa, Y. Eishi, T. Yokoyama.

Collection and assembly of data: T. Ohkusa.


Ann Intern Med. 2001;134(5):380-386. doi:10.7326/0003-4819-134-5-200103060-00010
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Background: Glandular atrophy and intestinal metaplasia are precancerous lesions; whether Helicobacter pylori eradication affects these lesions is controversial.

Objective: To determine whether H. pylori eradication is associated with improvement in glandular atrophy and intestinal metaplasia after at least 1 year.

Design: Single-blind, uncontrolled prospective trial.

Setting: Academic gastroenterology clinic in Japan.

Patients: 163 consecutive patients with dyspepsia and H. pylori infection.

Intervention: One-week course of a proton-pump inhibitor and antibiotic therapy.

Measurements: Endoscopic examination with antral and corporal biopsy was done before treatment and at 1 to 3 and 12 to 15 months after treatment. Gastritis, atrophy, and metaplasia were graded according to the updated Sydney System.

Results: In the 115 patients in whom H. pylori was eradicated, inflammation and mean neutrophil activity had decreased by 1 to 3 months, and both glandular atrophy in the corpus and intestinal metaplasia in the antrum had decreased by 12 to 15 months. Glandular atrophy in the corpus improved in 34 (89%) of 38 patients with atrophy before treatment, and intestinal metaplasia in the antrum improved in 28 (61%) of 46 patients who had metaplasia at baseline. In the 48 patients in whom eradication was unsuccessful, no significant histologic changes were observed.

Conclusion: In the year after successful H. pylori eradication, precancerous lesions improved in most patients.

Figures

Grahic Jump Location
Figure.
Predicted curves obtained by mixed-effects ordinal logistic regression models for histologic changes in the gastric mucosa in patients in whomHelicobacter pyloriinfection was or was not successfully eradicated(6).(6)H. pyloriH. pyloriP

Mean histologic scores were calculated for the two groups before treatment and at short-term (1 to 3 months) and long-term (12 to 15 months) follow-up. Findings were scored according to the updated Sydney System . Black symbols represent the patients in whom was eradicated; white symbols represent the patients in whom was not eradicated; squares represent the antrum; circles represent the corpus of the stomach. ***  < 0.001.

Grahic Jump Location

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Summary for Patients

Improvement of Precancerous Changes in the Stomach after Treatment of Helicobacter pylori Infection

The summary below is from the full report titled “Improvement in Atrophic Gastritis and Intestinal Metaplasia in Patients in Whom Helicobacter pylori Was Eradicated.” It is in the 6 March 2001 issue of Annals of Internal Medicine (volume 134, pages 380-386). The authors are T Ohkusa, K Fujiki, I Takashimizu, J Kumagai, T Tanizawa, Y Eishi, T Yokoyama, and M Watanabe.

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