Gastric mucosal changes, and sex differences therein, after Helicobacter pylori eradication: A long‐term prospective follow‐up study

Abstract

Background and Aim: Improvement of atrophic gastritis and intestinal metaplasia (IM) is considered to reduce the gastric cancer risk, but whether it can be achieved by H. pylori eradication (HPE) remains controversial. To evaluate the effect of HPE, we observed the gastric mucosa for up to17 years after HPE and sex differences in gastric mucosa. Methods: In total, 172 patients (94 males, 78 females) with HPE were enrolled. Annual histological evaluations were performed for up to 17 years. The grades of mononuclear cells, neutrophils, atrophy, IM in the antrum and corpus were evaluated using the updated Sydney system. Results: Relative to the pre-HPE period, atrophy had improved significantly 1 year after HPE in the antrum (1.50 ± 0.75 vs. 1.21 ± 1.25, P < 0.01) and corpus (0.59 ± 0.75 vs. 0.18 ± 0.52, P < 0.05). IM showed no significant change during 17 years after HPE at either biopsy site. Atrophy scores did not differ significantly between males and females. IM scores were significantly higher in males than in females before eradication (antrum, 0.67 ± 0.94 vs. 0.44 ± 0.77, P = 0.003, corpus, 0.20 ± 0.62 vs. 0.047 ± 0.21, P = 0.0027) and at most observation timepoints. Conclusions: During 17 years after HPE, atrophy, but not IM, improved significantly at the greater curvatures of the antrum and corpus. IM was significantly more severe in males than in females. Careful follow-up after HPE based on sex differences in gastric mucosal characteristics is important. MethodsStudy design and subjects. 607 patients in whom upper-gastrointestinal endoscopy was achieved, and who were diagnosed endoscopic gastritis, and with evaluation of histology, culture, rapid urease test, and serum anti-H. pylori antibody at Oita University Hospital (Oita, Japan) between August 1997 to December 2002 were enrolled in this study.The presence of H. pylori infection in these patients was confirmed by histopathological examination, culture, and the rapid

Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

“…This consideration, and the fact and only a minority (approximately 5%) of patients with severe atrophic gastritis may progress to gastric cancer, justifies H. pylori eradication even at the advanced stage of severe chronic atrophic gastritis 365. At present endoscopic surveillance is required to follow up patients with severe atrophic gastritis following H. pylori eradication but in the near future the molecular characterisation of gastritis will provide a more reliable assessment of patients who are cured or protected from progression to gastric cancer 366 367…”

Differences in clinical features and morphology between differentiated and undifferentiated gastric cancer after Helicobacter pylori eradication

“…Vauhkonen et al reported that although DGC occurred frequently in the setting of atrophic gastritis and intestinal metaplasia, UGC often arose in the absence of these abnormalities [42]. Gastric atrophy and/or intestinal metaplasia are more severe in males than in females [43,44]; consequently, we suggest that the male preponderance of post-HPE DGC may be related to the differential sex-based severity of these predisposing conditions. Take also reported that UGC is more common in cases with mild gastric atrophy [14].…”

Linked color imaging effectively detects the endoscopic atrophic border in transnasal endoscopy

“…A diagnosis of endoscopic atrophy is based on the disap­pearance and discoloration of mucosal folds and increased vascular translucency. However, in many cases, it is difficult to evaluate the atrophic border, especially when the gastric mucosa is partially regenerated and the atrophy has improved after eradication treatment.‍ ( 29 ) Takeda et al ‍ ( 12 ) reported that LCI produced superior visibility of the atrophy boundary to that visualized by WLI alone in 42.1% of cases. Mizukami et al ‍ ( 18 ) also objectively evaluated the color difference of the atrophy boundary in the CIE 1976 L*a*b* color space, and reported that it was 14.79 ± 6.68 for LCI and 11.06 ± 5.44 for WLI; this difference was significant.…”

“…The color difference was also significantly different between people with a current infection and those who had been previously infected. Atrophy findings differ between endoscopic and histological methods and the degree of improvement in atrophy after eradication also differs when assessed using endoscopic and histological approaches.‍ ( 29 ) Especially after eradication, atrophy is improved, and atrophied and non-atrophied mucosa coexist, which often makes endoscopic diagnosis difficult. This divergence may disappear when endoscopy is combined with LCI.…”