Gastric Atrophy and Intestinal Metaplasia before and after Helicobacter pylori Eradication: A Meta-Analysis

Abstract

Objective: Whether gastric atrophy (GA) and intestinal metaplasia (IM) are reversible after the eradication of Helicobacter pylori remains controversial. The purpose of this meta-analysis was to systematically review histological alterations in GA and IM by comparing histological scores before and after H. pylori eradication. Methods: English-language articles in the medical literature containing information about the association between infection with H. pylori and gastric premalignant lesions (i.e. GA and IM) were identified by searching the Medline, PubMed, and EMBASE databases with suitable key words up to December 2009. Review Manager 4.2.8 was used for the meta-analysis. Results: Twelve studies containing a total of 2,658 patients were included in the first meta-analysis. Before treatment, 2,648 patients had antrum GA, 2,401 patients had corpus GA, 2,582 patients had antrum IM, and 2,460 patients had corpus IM. Comparing the histological alterations before and after H. pylori eradication, the pooled weighted mean difference (WMD) with 95% CI for antral GA was 0.12 (0.00–0.23), p = 0.06. For corpus GA, the pooled WMD was 0.32 (0.09–0.54), p = 0.006. For antral IM, the pooled WMD was 0.02 (–0.12–0.16), p = 0.76, and for corpus IM, the pooled WMD was –0.02 (–0.05–0.02), p = 0.42. Conclusion: Our study shows that eradication of H. pylori results in significant improvement in GA in the corpus but not in the antrum; it also does not improve gastric mucous IM. Consequently, all patients with GA in the corpus should be tested for H. pylori infection, and eradication therapy should be prescribed for H. pylori-positive patients in those with GA in corpus.

Risk factors for synchronous or metachronous tumor development after endoscopic resection of gastric neoplasms

“…Although H. pylori is well known to be associated with development of atrophic gastritis, intestinal metaplasia, and gastric cancer, there is no clear evidence that intestinal metaplasia is improved by H. pylori eradication [20,21]. It seems that once intestinal metaplasia develops, H. pylori eradication cannot prevent malignant progression.…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…A key issue in establishing gastric cancer prevention strategies is to define the exact point within the evolutionary cascade of chronic gastritis from which regression of histological changes after eradication of the microorganism is no longer observed. Although controversial, due to possible sampling errors, a recent meta-analysis suggests that atrophic gastritis of the corpus can reverse after H pylori eradication (203) .…”

“…This can be explained by the smaller number of gastric glands in the normal antral mucosa (18,152) . The results of H pylori eradication on atrophic gastritis are often controversial (38,102,111,203) . A recent meta-analysis study involving 12 trials analyzing 2,648 patients with atrophic gastritis of the antrum found no significant reversibility of atrophic changes in the antrum following H pylori eradication (203) .…”

“…These cells are easily identified in the gastric mucosa since they are not present in the normal gastric mucosa and their identification presents high inter-observer agreement (18) . Although it also presents discordant studies, different studies and meta-analysis have been unable to demonstrate intestinal metaplasia regression after H pylori eradication (113,121,153,172,203,213) .…”

“Serological biopsy” and screening of gastric cancer

“…Мета-анализ 12 исследований (2658 больных) показал, что устранение H. pylori способствует выраженному уменьшению атрофии в теле же-лудка, но не в антральном отделе, и не оказыва-ет влияния на кишечную метаплазию [17]. Вот почему консенсус «Маастрихт-4» отмечает, что наилучшие результаты канцеропревенции до-стигнуты в группе больных, у которых эрадика-ция H. pylori проводилась до появления первых признаков атрофии СОЖ.…”