Het effect van Helicobacter pylori-eradicatie op het verloop van gastritis in relatie tot de virulentiefactor cagA; een prospectief onderzoek met 1 jaar follow-up

To study whether infection with cagA⁺ H. pylori is related to a specific clinical outcome and whether H. pylori eradication resolves atrophy and intestinal metaplasia.

Design

Prospective.

Methods

The cagA status of H. pylori isolated from 155 consecutive dyspeptic patients visiting the department of Gastro-enterology of the Academic Medical Centre in Amsterdam, the Netherlands, in October 1993-October 1995, was related to findings before and after successful eradication of H. pylori . At pretreatment, after 4-6 weeks, and on average 1 year after eradication therapy, the degree of gastritis and the H. pylori status were assessed by culture and histopathology of biopsies.

Results

CagA⁺ H. pylori were recovered from 122/155 (79%) H. pylori-infected patients, cagA^- H. pylori from 33/155 infected patients. Pretreatment degrees of gastritis activity, superficial epithelial damage, atrophy and intestinal metaplasia were significantly higher in cagA⁺ H. pylori infection (p < 0,001). After successful H. pylori eradication an improvement of activity of gastritis and superficial epithelial damage occurred (p < 0,001), but the degree of atrophy and intestinal metaplasia remained unchanged, irrespective of the cagA status.

Conclusions

Presence of cagA relates to more severe gastritis, atrophy and intestinal metaplasia, but does not influence the final clinical outcome, one year after successful H. pylori eradication. The usefulness of H. pylori eradication to revert precancerous lesions like atrophy and intestinal metaplasia is questionable.