H. pylori eradication prevents progression of intestinal metaplasia

NEW YORK (Reuters Health) - Eradication of Helicobacter pylori prevents progression of gastric intestinal metaplasia (Barrett's esophagus) in patients with gastroesophageal reflux disease (GERD) who use proton pump inhibitors, according to a report in the July issue of the American Journal of Gastroenterology.

"Long-term usage of proton pump inhibitors is rather common for the patients with GERD," Dr. Bor-Shyang Sheu from National Cheng Kung University Medical Center, Tainan, Taiwan, Republic of China, told Reuters Health. "Once H. pylori is negative, the likelihood of remaining free from progression of precancerous changes is quite high."

Dr. Sheu and colleagues investigated whether H. pylori eradication in patients with GERD using long-term esomeprazole would decrease or arrest the development or induce regression of precancerous lesions such as gastric atrophy and intestinal metaplasia.

In the H. pylori-positive group that underwent eradication, gastritis dramatically decreased, the authors report, whereas gastritis persisted in the H. pylori-positive non-eradication group.

The prevalence of gastric atrophy declined significantly during the first and second year of follow-up in the eradication group, and the prevalence of intestinal metaplasia decreased significantly in the second year, but the prevalence rates of gastric atrophy and intestinal metaplasia increased in the second year in the H. pylori-positive non-eradication group.

Moreover, the researchers note, patients in the eradication group had more regression and less development of gastric atrophy and intestinal metaplasia than did patients in the non-eradication group.

Gastric atrophy and intestinal metaplasia rates did not differ according to whether patients received continuous or on-demand therapy with esomeprazole.

"Screening for and eradicating H. pylori infection in patients using long-term esomeprazole for reflux esophagitis are necessary to prevent new occurrence, limit the progression, and promote the regression of precancerous changes such as gastric atrophy and intestinal metaplasia," the investigators conclude.

"Treatment of H. pylori will prevent ulcer relapse, new ulcers, and, possibly, newly developed precancerous change, progression of pre-existing precancerous changes, or even reverse precancerous changes," Dr. Sheu said. "Therefore, it may be possible to decrease the rate of gastric cancer."

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