Ohkusa T, Fujiki K, Takashimizu I, Kumagai J, Tanizawa T, Eishi Y, Yokoyama T, Watanabe M
Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Ann Intern Med. 2001 Mar 6;134(5):380-6. doi: 10.7326/0003-4819-134-5-200103060-00010.
Glandular atrophy and intestinal metaplasia are precancerous lesions; whether Helicobacter pylori eradication affects these lesions is controversial.
To determine whether H. pylori eradication is associated with improvement in glandular atrophy and intestinal metaplasia after at least 1 year.
Single-blind, uncontrolled prospective trial.
Academic gastroenterology clinic in Japan.
163 consecutive patients with dyspepsia and H. pylori infection.
One-week course of a proton-pump inhibitor and antibiotic therapy.
Endoscopic examination with antral and corporal biopsy was done before treatment and at 1 to 3 and 12 to 15 months after treatment. Gastritis, atrophy, and metaplasia were graded according to the updated Sydney System.
In the 115 patients in whom H. pylori was eradicated, inflammation and mean neutrophil activity had decreased by 1 to 3 months, and both glandular atrophy in the corpus and intestinal metaplasia in the antrum had decreased by 12 to 15 months. Glandular atrophy in the corpus improved in 34 (89%) of 38 patients with atrophy before treatment, and intestinal metaplasia in the antrum improved in 28 (61%) of 46 patients who had metaplasia at baseline. In the 48 patients in whom eradication was unsuccessful, no significant histologic changes were observed.
In the year after successful H. pylori eradication, precancerous lesions improved in most patients.
腺体萎缩和肠化生是癌前病变；幽门螺杆菌根除治疗是否会影响这些病变存在争议。
确定幽门螺杆菌根除治疗至少1年后是否与腺体萎缩和肠化生的改善相关。
单盲、非对照前瞻性试验。
日本的学术性胃肠病诊所。
163例连续的消化不良且感染幽门螺杆菌的患者。
质子泵抑制剂和抗生素治疗1周疗程。
治疗前以及治疗后1至3个月和12至15个月进行内镜检查并取胃窦和胃体活检。根据更新的悉尼系统对胃炎、萎缩和化生进行分级。
在115例幽门螺杆菌被根除的患者中，炎症和平均中性粒细胞活性在1至3个月时下降，胃体的腺体萎缩和胃窦的肠化生在12至15个月时均下降。治疗前有萎缩的38例患者中，34例（89%）胃体的腺体萎缩得到改善；基线时有化生的46例患者中，28例（61%）胃窦的肠化生得到改善。在48例根除治疗未成功的患者中，未观察到明显的组织学变化。
在成功根除幽门螺杆菌后的一年里，大多数患者的癌前病变得到改善。
