Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial

Kuipers E J; Nelis G F; Klinkenberg-Knol E C; Snel P; Goldfain D; Kolkman J J; Festen H P M; Dent J; Zeitoun P; Havu N; Lamm M; Walan A
January 2004
Gut;Jan2004, Vol. 53 Issue 1, p12
Academic Journal
BACKGROUND: Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective randomised study aimed to investigate whether H pylori eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastro-oesophageal reflux disease (GORD). METHODS: A total of 231 H pylori positive GORD patients who had been treated for > or =12 months with omeprazole maintenance therapy (OM) were randomised to either continuation of OM (OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and H pylori density. RESULTS: Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, H pylori was eradicated in 90 (88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus (p<0.001, baseline v two years). Atrophic gastritis also improved in the corpus (p<0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased (p<0.01). H pylori eradication did not alter the dose of omeprazole required, or reflux symptoms. CONCLUSIONS: Most H pylori positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of H pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. H pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of H pylori in GORD patients receiving long term acid suppression.


Related Articles

  • Lack of Effect of Treating. Blum, André L.; Talley, Nicholas J.; O'Moráin, Colm; van Zanten, Sander Veldhuyzen; Labenz, Joachim; Stolte, Manfred; Louw, Japie A.; Stubberöd, Arild; Theodórs, Asgeir; Sundin, Marie; Bolling-Sternevald, Elisabeth; Junghard, Ola // New England Journal of Medicine;12/24/98, Vol. 339 Issue 26, p1875 

    Background: It is uncertain whether treatment of Helicobacter pylori infection relieves symptoms in patients with nonulcer, or functional, dyspepsia. Methods: We conducted a double-blind, multicenter trial of patients with H. pylori infection and dyspeptic symptoms (moderate-to-very-severe pain...

  • Helicobacter pylori water soluble surface proteins prime human neutrophils for enhanced production of reactive oxygen species and stimulate chemokine production. Shimoyama, T.; Fukuda, S.; Liu, Q.; Nakaji, S.; Fukuda, Y.; Sugawara, K. // Journal of Clinical Pathology;May2003, Vol. 56 Issue 5, p348 

    Backgrounds/Aims: Chronic gastritis induced by Helicobacter pylori is characterised by considerable neutrophil infiltration into the gastric mucosa without mucosal invasion of bacteria. Bacteria have different characteristics with respect to their ability to stimulate human neutrophils to...

  • Persistent Stomach Problems.  // Pediatrics for Parents;2000, Vol. 18 Issue 12, p9 

    Focuses on Helicobacter pylori gastritis in children.

  • Helicobacter pylori cagA+ strains and dissociation of gastric epithelial cell proliferation from... Peek Jr., Richard M.; Moss, Steven F. // JNCI: Journal of the National Cancer Institute;06/18/97, Vol. 89 Issue 12, p863 

    Presents a study of Helicobacter pylori infections among gastritis patients associated with an increased risk of gastric cancer. Background of Helicobacter pylori infection; Extent of bacterial response of host mechanisms; Relationship between apoptosis and histologic parameters of inflammation...

  • Empiric approach to dyspepsia: test and treat strategy vs PPI treatment. A randomized controlled study. Maes, G.; de Nucci, C.; Mechise, A.; Balzano, A. // Gut;Sep2002 Supplement 2, Vol. 51, pA92 

    Reduction in the endoscopic workload by means of case selection based on empiric therapies has been advocated in order to reduce the costs for dyspepsia. The present study compares the efficacy of the "H. pylori — Hptest and treat strategy" with an empiric omeprazole trial. Methods: 219...

  • Relationship between Helicobacter pylori infection and histologic features of gastritis in biopsy specimens in gastroduodenal diseases, including evaluation of diagnosis by polymerase chain reaction assay. Yamamura, Fuyuhiko; Yoshikawa, Nozomi; Akita, Yasushi; Mitamura, Keiji; Miyasaka, Nobuo // Journal of Gastroenterology;1999, Vol. 34 Issue 4, p461 

    Abstract: We investigated the relationship between Helicobacter pylori infection and the histologic features of gastritis in gastroduodenal disease, and evaluated the diagnostic usefulness of the polymerase chain reaction (PCR) assay for the detection of H. pylori before and after eradication...

  • Inflammatory Cytokine mRNA Expression during Early and Persistent Helicobacter pylori Infection in Nonhuman Primates. Harris, Paul R.; Smythies, Lesley E.; Smith, Phillip D.; Dubois, Andre // Journal of Infectious Diseases;2/1/2000, Vol. 181 Issue 2, p783 

    Studies inflammatory cytokine mRNA expression during early and persistent Helicobacter pylori infection in nonhuman primates. Most common cause of chronic active gastritis in humans; Presence of Helicobacter pylori in rhesus monkeys; Levels of gastric inflammation in Helicobacter...

  • Is Raised Helicobacter pylori Antibody Titre Enough to Decide Retreatment? Bibi, Safia; Ahmed, Waquaruddin; Arif, Ambreen; Alam, Syed Ejaz // Pakistan Journal of Medical Research;Jul2011, Vol. 50 Issue 3, p101 

    Background: Helicobacter pylori infection causes a rise in its antibodies which take almost a year to come to baseline following successful eradication treatment. Checking these values in between a year may give falsely high values and many patients may thus be over treated. Aims: To serially...

  • Quadruple therapy for eradication of Helicobacter pylori.  // Africa Health;May2011, Vol. 33 Issue 4, p64 

    The article reports on the randomized clinical trial which assesses the effectiveness of using the quadruple therapy of omeprazole, amoxicillin, clarithromycin, and bismuth for the eradication of Helicobacter pylori.


Read the Article


Sign out of this library

Other Topics