Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease:: results of a randomised controlled trial
Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease:: results of a randomised controlled trial
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作者：
Kuipers, EJ;Nelis, GF;Walan, A
背景：幽门螺杆菌胃炎可发展为腺萎缩和肠化生，这是胃癌的易感条件。幽门螺杆菌胃炎的严重程度与胃酸深度抑制有关。这项前瞻性随机研究旨在探讨奥美拉唑长期治疗胃食道反流病(GORD)期间根除幽门螺杆菌对胃炎及其后遗症的影响。方法：231例Hp阳性的GORD患者接受奥美拉唑维持治疗(OM)12个月或12个月以上，随机分为持续OM组(OM组，n=120)和OM加奥美拉唑、阿莫西林、克拉霉素组(OM组，n=111)。在基线以及一年和两年后进行标准化活检取样的内窥镜检查以及症状评估。根据悉尼胃炎活动度、炎症、萎缩、肠上皮化生和幽门螺杆菌密度分级系统对胃炎进行评估。结果：仅OM组和OM三联组入院时胃体炎症活动度分别为50%和55%。在OM三联组中，90例(88%)患者的幽门螺杆菌被根除，胃窦部和胃体部的活动和炎症显著减少(p<；0.001，基线v两年)。萎缩性胃炎在胃体也有改善(p<；0.001)，但在胃窦没有改善。在83例持续感染的单纯OM患者中，胃窦和胃体的炎症活动或萎缩没有改变，但炎症增加(P<；0.01)。结论：大多数Hp阳性的GORD患者在奥美拉唑维持治疗过程中以胃溃疡为主。根除幽门螺杆菌可消除胃粘膜炎症，并诱导小体腺萎缩消退。根除幽门螺杆菌不会加重反流性疾病，也不会导致需要增加奥美拉唑的维持剂量。因此，我们建议长期抑酸的GORD患者根除幽门螺杆菌。
Background: Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective randomised study aimed to investigate whether H pylori eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastrooesophageal reflux disease ( GORD).Methods: A total of 231 H pylori positive GORD patients who had been treated for greater than or equal to 12 months with omeprazole maintenance therapy ( OM) were randomised to either continuation of OM ( OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin ( OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and H pylori density.Results: Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, H pylori was eradicated in 90 ( 88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus ( p < 0.001, baseline v two years). Atrophic gastritis also improved in the corpus ( p < 0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased ( p < 0.01). H pylori eradication did not alter the dose of omeprazole required, or reflux symptoms.Conclusions: Most H pylori positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of H pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. H pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of H pylori in GORD patients receiving long term acid suppression.