Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan.
Digestion. 2012;85(2):126-30. doi: 10.1159/000334684. Epub 2012 Jan 19.
Helicobacter pylori has been shown to cause atrophic gastritis and intestinal metaplasia (IM), both of which are precancerous lesions. To clarify the mechanism by which H. pylori eradication prevents gastric cancer, we monitored atrophy and IM improvement in gastric mucosa over a long period after H. pylori eradication.
We monitored 118 patients (72 males, 46 females; mean age 61.3 ± 5.1 years) for a mean of 8.6 years (range 5-13) after successful H. pylori eradication. Biopsy specimens were taken from the greater curvatures of the antrum (A2) and the corpus (B2).
Atrophy was significantly decreased in patients with successful H. pylori eradication, both at A2 (from 1.60 ± 0.09 to 1.02 ± 0.08; p < 0.001) and B2 (from 0.71 ± 0.10 to 0.02 ± 0.02; p < 0.001), and IM score was significantly decreased at B2 (from 0.17 ± 0.12 to 0.00 ± 0.00; p < 0.05), but not at A2 (from 0.60 ± 0.11 to 0.43 ± 0.09; p = NS). In patients without successful eradication, however, there were no differences in scores over time. Before eradication, IM score was significantly higher in males than in females, both at A2 (0.81 ± 0.12 vs. 0.25 ± 0.10; p < 0.05) and B2 (0.32 ± 0.08 vs. 0.07 ± 0.04; p < 0.05).
We were able to monitor the gastric mucosa for a mean of 8.6 years after H. pylori eradication, the longest period reported to date. Significant improvements in gastric atrophy and IM after H. pylori eradication may decrease the risk of gastric cancer.
已证实幽门螺杆菌可引起萎缩性胃炎和肠上皮化生（IM），这两者都是癌前病变。为了阐明根除幽门螺杆菌预防胃癌的机制，我们在幽门螺杆菌根除后很长一段时间内监测胃黏膜的萎缩和 IM 改善情况。
我们监测了 118 例患者（72 名男性，46 名女性；平均年龄 61.3±5.1 岁），平均随访 8.6 年（5-13 年）。从胃窦（A2）和胃体（B2）的大弯侧取活检标本。
成功根除幽门螺杆菌的患者，A2 处的萎缩（从 1.60±0.09 降至 1.02±0.08；p<0.001）和 B2 处的萎缩（从 0.71±0.10 降至 0.02±0.02；p<0.001）均显著降低，B2 处的 IM 评分也显著降低（从 0.17±0.12 降至 0.00±0.00；p<0.05），但 A2 处无差异（从 0.60±0.11 降至 0.43±0.09；p=NS）。然而，在未成功根除的患者中，各时间点的评分无差异。在根除前，男性 A2（0.81±0.12 比 0.25±0.10；p<0.05）和 B2（0.32±0.08 比 0.07±0.04；p<0.05）处的 IM 评分均显著高于女性。
我们能够在幽门螺杆菌根除后平均随访 8.6 年，这是迄今为止报道的最长时间。根除幽门螺杆菌后胃萎缩和 IM 的显著改善可能降低胃癌的风险。
