Helicobacter pylori eradication therapy improves atrophic gastritis and intestinal metaplasia: a 5‐year prospective study of patients with atrophic gastritis

Abstract

Aim : To investigate the effect of the eradication of Helicobacter pylori on histological gastritis. Methods : Twenty‐six patients with moderate to severe atrophy received successful eradication therapy of H.pylori. Four patients dropped out and 22 were followed up prospectively for 5 years. The grades of gastritis were estimated from gastric biopsy specimens. The grade of intestinal metaplasia was also evaluated by dye‐endoscopy using methylene blue (methylthioninium chloride). The serum levels of pepsinogen, gastrin and anti‐parietal cell antibody were also determined. Results : The grades of atrophy decreased in patients with successful eradication therapy in the gastric corpus (before vs. 5 years after eradication, 2.09 ± 0.15 vs. 0.91 ± 0.17; P < 0.01) and in the antrum (2.14 ± 0.17 vs. 1.36 ± 0.17; P < 0.01). The levels of intestinal metaplasia were also decreased in the corpus (0.91 ± 0.24 vs. 0.50 ± 0.16; P < 0.05) and in the antrum (1.41 ± 0.20 vs. 1.00 ± 0.16; P < 0.05), which was also demonstrated by the methylene blue (methylthioninium chloride) staining method (33.4 ± 8.2% vs. 23.0 ± 6.5%; P < 0.05). The improvement of corpus atrophy correlated well with the high serum level of pepsinogen I (P = 0.005), but showed no correlation with the levels of anti‐parietal cell antibody. Conclusions : These results suggest that gastric atrophy and intestinal metaplasia are reversible events in some patients.