Helicobacter pylori-negative Gastritis in Erosive Esophagitis, Nonerosive Reflux Disease or Functional Dyspepsia Patients

Background: Although Helicobacter pylori infection is believed to be the main cause of chronic gastritis, a US clinical trial investigating the long-term effects of lansoprazole as maintenance therapy for erosive esophagitis revealed a surprisingly high prevalence (over 90%) and severity of chronic gastritis in H. pylori-negative subjects. Goals: This study aims to compare prevalence and severity of chronic gastritis of the body and antrum in H. pylori-negative subjects with erosive esophagitis, nonerosive reflux disease, or functional dyspepsia from several trials. Study: Pretreatment gastric histology was compared in 1595 H. pylori-negative subjects with erosive esophagitis (>= grade 2; n = 196), nonerosive reflux disease (n = 688), or functional dyspepsia (n = 711) who participated in US Takeda-sponsored lansoprazole trials. Results: Pretreatment histology data from US clinical studies showed that 67.5% and 75.0% of H. pylori-negative adult subjects with erosive esophagitis had moderate or severe body and antral chronic gastritis, respectively. Chronic gastritis was also observed in H. pylori-negative subjects with nonerosive reflux disease or functional dyspepsia, although prevalence was significantly less (P < 0.001) than in erosive esophagitis. Conclusions: Chronic gastritis in H. pylori-negative subjects is more common than previously appreciated. These results highlight the need for better characterization of gastric mucosal histology in these gastrointestinal disorders.