Eradication of Helicobacter pylori infection improved gastric mucosal atrophy and prevented progression of intestinal metaplasia, especially in the elderly population: A long‐term prospective cohort study

Abstract

Eradication of H. pylori infection improved gastric atrophy and prevented the progression of intestinal metaplasia in the elderly population during the long-term follow-up periods. H. pylori eradication for the elderly population is effective.

ETIOPATHOGENESIS OF PEPTIC ULCER: back to the past?

“…It remains controversial whether gastric mucosal atrophy and duodenal metaplasia are reversible or not after eradication of the infection (62) . Furthermore, such possible mucosal alterations are difficult to confirm in consequence of not being possible, in the majority of cases, to obtain data on the previous conditions with respect to the presence of H. pylori in the population included in the studies (20,62) . Anatomopathological studies on peptic ulcers refer signs of inflammation in the regions surrounding the ulcer but not signs of mucosal atrophy (62) .…”

“…Furthermore, such possible mucosal alterations are difficult to confirm in consequence of not being possible, in the majority of cases, to obtain data on the previous conditions with respect to the presence of H. pylori in the population included in the studies (20,62) . Anatomopathological studies on peptic ulcers refer signs of inflammation in the regions surrounding the ulcer but not signs of mucosal atrophy (62) . About 30% of patients with idiopathic ulcers show histological characteristics suggestive of previous infection, indicating that eradication of the infection does not protect against recurrence of the peptic ulcer (15) .…”

“…Gisbert et al (24) observed that the rate of diagnostic sensitivity from biopsies with urease test and histological examination was of 83% in analyses of samples from corpus and antrum concomitantly, decreasing to 78% with material collected from only one of the regions. In order to be sure of the absence of the infectious cause of the peptic ulcer, it is also recommended that samples should be examined from both antrum and corpus, and utilizing two different tests, with negative results for both (62) . A lower bacterial density in the antrum can lead to false-negative urea respiratory tests (1,20,28,36) .…”

Accuracy of biopsies for Helicobacter pylori in the presence of intestinal metaplasia of the stomach

“…There has also been demonstration of stability of IM severity scores up to 10 years post-eradication of H. pylori, suggesting at the very least that treating the organism may prevent progression of this pre-cancerous condition over time (11)(12)(13).…”

Surveillance of Gastric Intestinal Metaplasia: Is It Warranted?

“…Despite ongoing controversy regarding the reversibility of IM with H. pylori eradication, there are now a non-negligible number of studies demonstrating improvement in IM severity [12][13][14][15][16][17] , or at the very least stability of IM scores with eradication [18][19][20] . Treatment of H. pylori has also been shown to decrease metachronous cancer risk in patients with dysplasia or early gastric cancer post endoscopic resection [21] .…”