RESUMEN
OBJECTIVE: To investigate the relationship between Helicobacter pylori (Hp) infection and gastric cancer through the changes of gastric mucosa histopathology within 5 years after Hp eradication in Hp-positive subjects in the high incidence region of gastric cancer. METHODS: One thousand and six adults were selected from general population in Yantai, Shandong Province, the high incidence region of gastric cancer. Gastroscopy and CLO test were performed in all subjects. Biopsy samples from the gastric antrum and body were obtained for histology and assessment of Hp infection. All the Hp-positive subjects were then randomly divided into two groups: treatment group receiving OAC triple therapy and placebo as controls. These subjects were endoscopically followed up in the second and fifth year. In this article, we compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and final visit. Statistical analysis was done by chi(2) test. RESULTS: All the 552 Hp-positive subjects were randomly divided into treatment group or control group, 276 in each. During the five-year follow-up, the number of patients who continued to be negative or positive for Hp was 161 and 198, respectively. Statistical analysis revealed that: (1) At the initial visit, there were no significant differences in the severity and activity of inflammation between the biopsy specimens from the antrum (P = 0.105) and body (P = 0.084) in both groups. But the proportion of atrophy and intestinal metaplasia in the antrum was much higher than that in the body (P = 0.000). (2) The severity and activity of inflammation in both the antrum and body were markedly reduced after Hp eradication (P = 0.000). (3) Within the five years after Hp eradication, intestinal metaplasia in the antrum regressed or had no progression, while the proportion of intestinal metaplasia in the Hp-positive group increased significantly (P = 0.032). (4) After Hp eradication, the atrophy in both the antrum and body had no significant regression. P value was 0.223 and 0.402, respectively. CONCLUSIONS: Hp eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum. On the other hand, continued Hp infection leads to progressive aggrevation of atrophy and intestinal metaplasia.
Asunto(s)
Mucosa Gástrica/patología , Infecciones por Helicobacter/patología , Helicobacter pylori , Adulto , Anciano , Atrofia , Femenino , Estudios de Seguimiento , Mucosa Gástrica/microbiología , Gastritis Atrófica/microbiología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Masculino , Metaplasia , Persona de Mediana Edad , Neoplasias Gástricas/microbiologíaRESUMEN
<p><b>OBJECTIVES</b>To investigate the relationship between H. pylori infection, gastric cancer and other gastric diseases through the changes in gastric mucosa and the status of different gastric diseases within 5 years after H. pylori eradication in H. pylori-positive subjects in a high incidence region of gastric cancer.</p><p><b>METHODS</b>One thousand and six adults were selected from the general population in Yantai, Shandong province, a high incidence region for gastric cancer in China. Gastroscopy and Campylobacter-like organism (CLO) testing were performed on all subjects. Biopsy samples from the gastric antrum and body were obtained for histology and assessment of H. pylori infection. All H. pylori-positive subjects were then randomly divided into two groups: treatment group receiving Omeprazole Amoxicillin Clarythromycin (OAC) triple therapy and placebo as controls. These subjects were endoscopically followed up in the second and fifth year. We compared the endoscopic appearance and histology of the biopsy specimens from the same site obtained at the first and last visits.</p><p><b>RESULTS</b>All 552 H. pylori-positive subjects were randomly and evenly divided into treatment group or control group. During the five-year follow-up, the numbers of patients who continued to be negative or positive for H. pylori were 161 and 198, respectively. Statistical analysis revealed that: (1) At the initial visit, there were no significant differences in the severity and activity of inflammation, atrophy and intestinal metaplasia between the biopsy specimens from the antrum and body respectively in both groups. (2) The severity and activity of inflammation in both the antrum and body were markedly reduced after H. pylori eradication (P = 0.000). (3) Within five years after H. pylori eradication, intestinal metaplasia in the antrum either regressed or had no progression, while the proportion of intestinal metaplasia in the H. pylori-positive group increased significantly (P = 0.032). (4) After H. pylori eradication, the atrophy in both the antrum and body had no significant regression. The P value was 0.223 and 0.402, respectively.</p><p><b>CONCLUSIONS</b>H. pylori eradication results in remarkable reduction in the severity and activity of chronic gastritis, marked resolution of intestinal metaplasia in the antrum. On the other hand, continuous H. pylori infection leads to progressive aggravation of atrophy and intestinal metaplasia.</p>