Does Acid Suppression by Antacids and H2 Receptor Antagonists Increase the Incidence of Atrophic Gastritis in Patients With or Without H. pylori Gastritis?

Abstract

Currently there is controversial evidence that suggests that the accepted incidence of atrophic gastritis of 1.2 to 3.3% in patients with Helicobacter pylori gastritis may be increased by the long-term suppression of acid by a proton pump inhibitor (omeprazole). The purpose of this study is to show whether lesser forms of acid suppression by antacids or H2 receptor antagonists may have an influence on the development of atrophic gastritis. The authors recently reported a study in which a cohort of 36 patients with symptoms of dyspepsia were followed clinically for a period of 7 to 19 years. In that report all subjects underwent upper endoscopy with two biopsy specimens each from the antrum and fundus, on at least two occasions, 7 to 19 years apart. A diagnosis of atrophic gastritis was based on the interpretation of these biopsies by two gastrointestinal pathologists. The presence of H. pylori colonization was determined by tissue sampling and by a campylobacter-like organisms test of the antrum. Of the 36 patients in the authors' previous report, 33 had adequate baseline and follow-up data on medications consumed throughout the period of the study. In their current report they now present the findings of a retrospective review in which they correlate the presence of atrophic gastritis with the sole use of antacids and H2 receptor antagonists throughout the period of the study. In the cohort of 33 patients evaluated from the previous report, the authors found that atrophic gastritis had developed in all 28 patients positive for H. pylori, and in none of the 5 patients negative for H. pylori (p < 0.0001). A retrospective analysis of this previously studied cohort of 33 patients revealed that the use of antacids and H2 receptor antagonists did not predict the development of atrophic gastritis in either H. pylori-negative or -positive subjects. In a retrospective analysis of a cohort of 33 patients followed for an average of 11.7 years, atrophic gastritis developed in H. pylori-positive but not in H. pylori-negative subjects, irrespective of the use and duration of antacids or H2 receptor antagonists.

Incidence of chronic atrophic gastritis: systematic review and meta-analysis of follow-up studies

“…Another 4 articles were excluded for the following reasons: all patients had either chronic gastritis or CAG at baseline, incidence of CAG was based on biopsies and not on study participants, incidence of CAG and metaplasia or either of them were grouped together and in one study, no mean follow-up time could be estimated. Due to these exclusions, only 14 studies (from 15 articles) with information on the incidence of CAG could be included in this review [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. According to the above described criteria, all of these studies included more than 15 study participants who were diagnosed to be free of CAG at baseline, either by histology ('normal' or 'superficial gastritis') or by serum pepsinogen (PG) levels.…”

“…2 of the studies were conducted in multiple centres in different countries [20,22]. Studies were carried out in Sweden, [10] Columbia, [11] the Netherlands, [12,13] the Netherlands and Sweden, [14] Finland, [15] Estonia, [16,24] Japan, [17,23] USA, [18] Slovenia, [19] Australia, Canada, Germany, and the Netherlands, [20] Germany [21] and Denmark, Finland, Norway and Sweden [22]. Most of the studies were not population-based and consisted of symptomatic patients.…”

Proton pump inhibitors and H. pylori infection: Why the concern?

“…In the original longterm study [2], grading of IM was said to be based on the Sydney system, but the only reporting of IM was that one out of 59 H. pylori-positive patients had IM at baseline, and three patients had it at the end of the study. In the lansoprazole study and the antacid/H2 study [3,4], there was no data given for intestinal metaplasia, and in the former it was not even mentioned as having been assessed.…”

“…This is a small study, but of interest for its long-term follow-up and because it represented patients with non-PP acid suppression [4]. Thirty-three patients were followe for 7 to 19 years.…”

“…This Clinical Trials Review addresses all three questions by examining evidence from two studies with omeprazole [1,2], one study with lansoprazole [3], and a personal series with long-term follow-up on antacids and H2 receptor antagonists [4]. This topic will remain under active scrutiny for the foreseeable future, so it is hoped that this review will assist the reader in the critical assessment o results from future studies and of currently existing reports.…”