Precancerous conditions after H. pylori eradication: a randomized double blind study in first degree relatives of gastric cancer patients

ABSTRACT

Regression of precancerous lesions after H. pylori eradication remains controversial. This study evaluates the change and topography in first degree relatives [FOR] of gastric cancer [GC] patients following H. pylori eradication. Participants underwent endoscopy with antrum and corpus histological examinations. Subjects with pangastritis were randomly allocated to placebo or eradication therapy and followed over 41/2 years. Among 989 evaluated FDR, we excluded 468 patients as follows 108 had macroscopic lesions, 243 had no evidence of any H. pylori infection, and 117 were excluded for other reasons. The remaining subjects [n = 521] were allocated to therapy [group A, n = 261] or placebo [group B, n = 260] groups. Interim analysis of 403 subjects [201 placebo, 202 therapy] showed regression of atrophy [60 out of 97 in the antrum and 37 out of 104 in the corpus] in H. pylori-eradicated versus regression of atrophy [57 out of 184 in the antrum and 23 out of 173 in the corpus] in non-H. pylori-eradicated cases over 21/2 years [P < 0.0001]. No regression of intestinal metaplasia [IM] occurred in the antrum and corpus of treated subjects over 41/2 years. However, progression of IM occurred in the antrum in 17 out of 90 patients in the non-H. pylori-eradicated versus 4 out of 68 H. pylori-eradicated subjects after 41/2 years [P < 0.05]. Eradication of H. pylori is associated with regression of gastric atrophy but not IM, even in its early stages. Gastric atrophy and IM in the antrum have shown more rapid progression in cases not treated for H. pylori infection [over 41/2 years follow-up] compared to H. pylori-eradicated cases