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

SUMMARY 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.