Eradication of Helicobacter pylori infection significantly slows down the progression of precancerous lesions in high risk population: a 5-year prospective randomized study

Abstract

AIMS: To examine the effects of H. pytori eradication on gastric precancerous lesions in a high risk population in China. METHOD: 2423 healthy individuals aged 35 to 65 were recruited in Changle (standardized mortality rate of gastric cancer in males- 153/100,000), Fujian, China for a screening endoscopic study in 1994. Patients without endoscopic lesions and positive for H. pylori infection by rapid urease test and histology (n=1628) were randomized to receive two-week course of omeprazole, amoxycillin/clavulanate and metronidazole (n = 819) or placebo (n = 809). Upper endoscopy was performed with biopsy specimens obtained from the antrum and corpus at baseline and repeated in 1999. 927 subjects had available (pre / post) histology for evaluation (508 in triple group and 419 in placebo group). Histological assessment was performed according to Updated Sydney Classification by a single blinded pathologist. Patients were graded according to advancing stages of gastritis, gastric atrophy, intestinal metaplasia and dysplasia. Progression or regression in histology required at least one grade higher or lower respectively. RESULT: The age, sex distribution and mean baseline histologic scores were similar between the two groups. CONCLUSION: H. pylori eradication slowed the progression of gastric atrophy at both antrum and the corpus significantly; and slowed the progression of intestinal metaplasia in corpus only. H. pylori eradication is beneficial in halting the progression of gastric precancerous lesions in high risk population at 5-year follow-up.