Satoh K, Kimura K, Takimoto T, Kihira K
Department of Gastroenterology, Jichi Medical School, Tochigi, Japan.
Helicobacter. 1998 Dec;3(4):236-40.
Opinions differ as to whether atrophic gastritis and intestinal metaplasia (IM) improve after Helicobacter pylori eradication. We investigated the change of the severity of atrophy and IM after H. pylori eradication.
Twenty H. pylori-positive patients with histologically confirmed atrophic gastritis received anti-H. pylori therapy and achieved eradication. They were followed for 12-33 months (median 17 months) after the therapy. Biopsies were taken from the lesser and greater curvatures of the mid-antrum and middle body, and the incisura angularis of the stomach. The state of H. pylori infection was assessed histologically (Giemsa stain). Histological severity of atrophy and IM was graded according to the Updated Sydney System and scored on a 0-3 scale. The scores of atrophy and IM were compared between before and after the therapy (at the end of follow-up).
No significant difference was found in the scores of antral or body atrophy between before and after the therapy. Scores of antral IM increased after the therapy, whereas those of body IM did not change significantly. Development of IM in the whole stomach was found in three of seven patients who had no IM before the therapy. All of them were male smokers and drinkers. In contrast, complete regression of IM was not found.
Our results cast doubt on the reversibility of atrophy and IM after H. pylori eradication. Development of IM could be found in some of patients with atrophy even after H. pylori eradication.
关于根除幽门螺杆菌后萎缩性胃炎和肠化生（IM）是否会改善，存在不同观点。我们研究了根除幽门螺杆菌后萎缩和IM严重程度的变化。
20例经组织学确诊为萎缩性胃炎的幽门螺杆菌阳性患者接受了抗幽门螺杆菌治疗并实现了根除。治疗后对他们进行了12 - 33个月（中位时间17个月）的随访。从胃窦中部和胃体中部的小弯侧和大弯侧以及胃角切迹处取活检组织。通过组织学检查（吉姆萨染色）评估幽门螺杆菌感染状态。根据更新的悉尼系统对萎缩和IM的组织学严重程度进行分级，并在0 - 3分的量表上评分。比较治疗前后（随访结束时）萎缩和IM的评分。
治疗前后胃窦或胃体萎缩评分无显著差异。治疗后胃窦IM评分增加，而胃体IM评分无显著变化。在治疗前无IM的7例患者中，有3例出现了全胃IM。他们均为男性吸烟者和饮酒者。相反，未发现IM完全消退。
我们的结果对根除幽门螺杆菌后萎缩和IM的可逆性提出了质疑。即使在根除幽门螺杆菌后，部分萎缩性胃炎患者仍可能出现IM。
