Changing patterns of Helicobacter pylori gastritis in long-standing acid suppression

被引:88
作者
Moayyedi, P
Wason, C
Peacock, R
Walan, A
Bardhan, K
Axon, ATR
Dixon, MF
机构
[1] Univ Leeds, Div Pathol Sci, Leeds LS2 9JT, W Yorkshire, England
[2] Gen Infirm, Ctr Digest Dis, Leeds LS1 3EX, W Yorkshire, England
[3] Rotherham Dist Gen Hosp, Rotherham, S Yorkshire, England
[4] AstraZeneca Clin Res, Edinburgh, Midlothian, Scotland
[5] AstraZeneca Hassle, Gothenburg, Sweden
关键词
D O I
10.1046/j.1523-5378.2000.00032.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background, Helicobacter pylori colonization and associated inflammation are influenced by local acid output. Infected subjects with acid-related diseases, such as gastroesophageal reflux disease (GERD) are likely to have an antral-predominant gastritis. We hypothesized that long-term acid suppression would result in relatively greater bacterial colonization in the corpus leading to diffuse or corpus-predominant gastritis and that this would be prevented by prior H. pylori eradication. Materials and Methods. To investigate this, we conducted a prospective, double-blind trial of the effect on gastric histology of 12-month maintenance treatment with omeprazole in H. pylori-positive GERD patients randomly assigned to either an eradication or omeprazole-alone regime. A control group of 20 H. pylori-negative GERD patients also received omeprazole throughout the study period. Biopsies taken at baseline and at 12 months were graded "blind" by a single observer according to the updated Sydney System. The 41 H. pylori-positive subjects with grade B or C esophagitis were randomly assigned (20 to omeprazole alone, 21 to eradication) and 33 subjects completed the 12-month study. Results. There was a significant decline in antral chronic inflammation in initially positive patients between baseline and end in both the eradication group (p = .035) and the omeprazole-alone group (p = .008). However, corpus chronic inflammation increased in the omeprazole-alone group (p = .0156) but decreased in the eradication group. The change toward corpus predominance between baseline and end for the omeprazole-alone group is highly significant (p = .0078). Furthermore, 5 of 11 in the omeprazole-alone group developed mild corpus atrophy, compared to 0 of 8 who had undergone H. pylori eradication. The change in frequency of corpus atrophy between the two groups is significant (p = .02). Conclusion. In H. pylori-positive subjects with GERD, long-term acid suppression leads to a shift from antral-to corpus-predominant gastritis that can be prevented by prior eradication. The shift is accompanied by an increase in corpus atrophy. H. pylori infection should be eradicated prior to long-term acid suppression with proton pump inhibitors.
引用
收藏
页码:206 / 214
页数:9
相关论文
共 37 条
[1]   The endoscopic assessment of esophagitis: A progress report on observer agreement [J].
Armstrong, D ;
Bennett, JR ;
Blum, AL ;
Dent, J ;
deDombal, FT ;
Galmiche, JP ;
Lundell, L ;
Margulies, M ;
Richter, JE ;
Spechler, SJ ;
Tytgat, GNJ ;
Wallin, L .
GASTROENTEROLOGY, 1996, 111 (01) :85-92
[2]   Helicobacter pylori gastritis and epithelial cell proliferation in patients with reflux oesophagitis after treatment with lansoprazole [J].
Berstad, AE ;
Hatlebakk, JG ;
Maartmann-Moe, H ;
Berstad, A ;
Brandtzaeg, P .
GUT, 1997, 41 (06) :740-747
[3]  
CARIANI G, 1992, EUR J GASTROEN HEPAT, V4, P867
[4]   THE IMPORTANCE OF LOCAL ACID PRODUCTION IN THE DISTRIBUTION OF HELICOBACTER-FELIS IN THE MOUSE STOMACH [J].
DANON, SJ ;
OROURKE, JL ;
MOSS, ND ;
LEE, A .
GASTROENTEROLOGY, 1995, 108 (05) :1386-1395
[5]   RELATIONSHIP BETWEEN INFECTIVE LOAD OF HELICOBACTER-PYLORI AND REACTIVE OXYGEN METABOLITE PRODUCTION IN ANTRAL MUCOSA [J].
DAVIES, GR ;
BANATVALA, N ;
COLLINS, CE ;
SHEAFF, MT ;
ABDI, Y ;
CLEMENTS, L ;
RAMPTON, DS .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1994, 29 (05) :419-424
[6]  
DAY DW, 1995, BIOPSY PATHOLOGY OES, P109
[7]  
DIXON M, 1993, LANCET, V342, P384, DOI 10.1016/0140-6736(93)92808-7
[8]   HELICOBACTER-PYLORI AND PEPTIC-ULCERATION - HISTOPATHOLOGICAL ASPECTS [J].
DIXON, MF .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 1991, 6 (02) :125-130
[9]   Classification and grading of gastritis - The updated Sydney System [J].
Dixon, MF ;
Genta, RM ;
Yardley, JH ;
Correa, P ;
Batts, KP ;
Dahms, BB ;
Filipe, MI ;
Haggitt, RC ;
Haot, J ;
Hui, PK ;
Lechago, J ;
Lewin, K ;
Offerhaus, JA ;
Price, AB ;
Riddell, RH ;
Sipponen, P ;
Solcia, E ;
Watanabe, H .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1996, 20 (10) :1161-1181
[10]   Gastric mucosa during treatment with lansoprazole: Helicobacter pylori is a risk factor for argyrophil cell hyperplasia [J].
Eissele, R ;
Brunner, G ;
Simon, B ;
Solcia, E ;
Arnold, R .
GASTROENTEROLOGY, 1997, 112 (03) :707-717