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document
Atrophy and intestinal metaplasia one year after cure of H. pylori infection : a prospective , randomized study . BACKGROUND & AIMS Helicobacter pylori-infected gastric mucosa evolves through stages of chronic gastritis , intestinal metaplasia ( IM ) , glandular atrophy ( GA ) , and dysplasia before carcinoma develops . We studied if H. pylori eradication would alter the course of premalignant histologic changes in the stomach . METHODS Volunteers from the Yantai County in China underwent upper endoscopy with biopsy specimens obtained from the antrum and corpus . H. pylori-infected subjects were randomized to receive either a 1-week course of omeprazole , amoxicillin , and clarithromycin ( OAC ) or placebo . At 1 year , endoscopies with biopsies were repeated . RESULTS A total of 587 H. pylori-infected subjects were randomized to OAC ( n = 295 ) and placebo ( n = 292 ) . At 1 year , H. pylori was eradicated in 226 subjects assigned to OAC . In the placebo group , 245 patients remained H. pylori infected . Analysis of paired samples obtained from the same patients showed that acute and chronic gastritis decreased in both the antrum and corpus after H. pylori eradication ( P < 0.001 ) and activity of IM decreased in antrum ( P = 0.014 ) . In the H. pylori-infected group , antral biopsy specimens had more pronounced acute gastritis ( P = 0.01 ) , whereas corpus specimens showed increased acute and chronic gastritis ( P < 0.001 ) and a marginal increase in GA ( P = 0.052 ) . When histologic changes were compared between the 2 groups , decrease in acute and chronic gastritis was more frequent after H. pylori eradication ( P < 0.001 ) but changes in IM were similar . In the H. pylori-infected group , increase in GA was seen in the corpus ( P = 0.01 ) . CONCLUSIONS At 1 year , H. pylori eradication is beneficial in preventing progression of pathologic changes of the gastric mucosa .
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Intervention_Physical
upper endoscopy with biopsy
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Intervention_Pharmacological
1-week course of omeprazole , amoxicillin , and clarithromycin ( OAC )
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Intervention_Control
placebo
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Intervention_Pharmacological
OAC
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Intervention_Pharmacological
OAC
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Intervention_Control
placebo
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Outcome_Physical
acute and chronic gastritis
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Outcome_Physical
activity of IM
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Outcome_Physical
acute gastritis
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Outcome_Physical
acute and chronic gastritis
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Outcome_Physical
GA
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Outcome_Physical
acute and chronic gastritis
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Outcome_Physical
IM
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Outcome_Physical
GA
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Outcome_Physical
pathologic changes
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Participant_Condition
intestinal metaplasia
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Participant_Condition
H. pylori infection
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Participant_Sample-size
587
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Participant_Sample-size
245