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The Reduction in Gastric Atrophy After Helicobacter pylori Eradication Is Reduced by Treatment With Inhibitors of Gastric Acid Secretion


The Reduction in Gastric Atrophy After Helicobacter pylori Eradication Is Reduced by Treatment With Inhibitors of Gastric Acid Secretion

Ryota Niikura et al. Int J Mol Sci.


Background: Helicobacter pylori (H. pylori) eradication therapy may improve gastric atrophy and intestinal metaplasia, but the results of previous studies have not always been consistent. The aim of this study was to compare the histological changes of intestinal metaplasia and gastric atrophy among the use of acid-suppressing drugs after H. pylori eradication.

Methods: A cohort of 242 patients who underwent successful eradication therapy for H. pylori gastritis and surveillance endoscopy examination from 1996 to 2015 was analyzed. Changes in the histological scores of intestinal metaplasia and atrophy according to drug use (proton-pump inhibitors (PPIs), H2 receptor antagonists (H2RAs), and non-acid suppressant use) were evaluated in biopsies of the antrum and corpus using a generalized linear mixed model in all patients.

Results: The mean follow-up period and number of biopsies were 5.48 ± 4.69 years and 2.62 ± 1.67 times, respectively. Improvement in the atrophy scores of both the antrum (p = 0.042) and corpus (p = 0.020) were significantly superior in patients with non-acid suppressant drug use compared with those of PPI and H2RA use. Metaplasia scores in both the antrum and corpus did not improve in all groups, and no significant differences were observed among groups in the antrum (p = 0.271) and corpus (p = 0.077).

Conclusions: Prolonged acid suppression by PPIs or H2RAs may limit the recovery of gastric atrophy following H. pylori eradication.

Keywords: H. pylori eradication; atrophy; proton pump inhibitors (PPIs).

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1
(A) Study flow chart; (B) Study time course. Abbreviation: EGD, Esophagogastroduodenoscopy; GSRS, gastrointestinal symptom rating scale.
Figure 2
Figure 2
Immunohistochemical stain of Caudal related homeobox gene (CDX)1 and CDX2 expression in the biopsied gastric mucosa: low positive (<50%) for CDX1 100× (A); high positive (>50%) for CDX1 100× (B); low positive (<50%) for CDX2 100× (C); high positive (>50%) for CDX2 100× (D).

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