Changing patterns of Helicobacter pylori gastritis in long-standing acid suppression

Helicobacter. 2000 Dec;5(4):206-14. doi: 10.1046/j.1523-5378.2000.00032.x.


Background: Helicobacter pylori colonization and associated inflammation are influenced by local acid output. Infected subjects with acid-related diseases, such as gastroesophageal reflux disease (GERD) are likely to have an antral-predominant gastritis. We hypothesized that long-term acid suppression would result in relatively greater bacterial colonization in the corpus leading to diffuse or corpus-predominant gastritis and that this would be prevented by prior H. pylori eradication.

Materials and methods: To investigate this, we conducted a prospective, double-blind trial of the effect on gastric histology of 12-month maintenance treatment with omeprazole in H. pylori-positive GERD patients randomly assigned to either an eradication or omeprazole-alone regime. A control group of 20 H. pylori-negative GERD patients also received omeprazole throughout the study period. Biopsies taken at baseline and at 12 months were graded "blind" by a single observer according to the updated Sydney System. The 41 H. pylori-positive subjects with grade B or C esophagitis were randomly assigned (20 to omeprazole alone, 21 to eradication) and 33 subjects completed the 12-month study.

Results: There was a significant decline in antral chronic inflammation in initially positive patients between baseline and end in both the eradication group (p =.035) and the omeprazole-alone group (p =.008). However, corpus chronic inflammation increased in the omeprazole-alone group (p =.0156) but decreased in the eradication group. The change toward corpus predominance between baseline and end for the omeprazole-alone group is highly significant (p =.0078). Furthermore, 5 of 11 in the omeprazole-alone group developed mild corpus atrophy, compared to 0 of 8 who had undergone H. pylori eradication. The change in frequency of corpus atrophy between the two groups is significant (p =.02).

Conclusion: In H. pylori-positive subjects with GERD, long-term acid suppression leads to a shift from antral- to corpus-predominant gastritis that can be prevented by prior eradication. The shift is accompanied by an increase in corpus atrophy. H. pylori infection should be eradicated prior to long-term acid suppression with proton pump inhibitors.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Ulcer Agents / therapeutic use*
  • Clarithromycin / therapeutic use
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Gastric Mucosa / microbiology*
  • Gastric Mucosa / pathology
  • Gastritis / drug therapy*
  • Gastritis / microbiology
  • Gastritis / pathology
  • Gastroesophageal Reflux / drug therapy
  • Helicobacter Infections / drug therapy
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / growth & development*
  • Humans
  • Hydrogen-Ion Concentration
  • Male
  • Middle Aged
  • Omeprazole / therapeutic use*
  • Prospective Studies
  • Tinidazole / therapeutic use


  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Tinidazole
  • Clarithromycin
  • Omeprazole