Relationship between recurrence of Barrett esophagus and Helicobacter pylori eradication therapy in the elderly / 中华老年医学杂志

ABSTRACT

Objective To investigate the relationship between the recurrence of Barrett esophagus (BE) and Helicobacter pylori (Hp) eradication therapy, according to endoscopic follow-up outcomes in the elderly patients with BE after endoscopic argon plasma coagulation (APC). Methods A total of 201 elderly patients were enrolled to be treated with APC, including 53 patients without Hp infection (control group) and 148 cases with Hp infection (infection group), then the infection group was randomly divided into two groups infection group A (n=74) and infection group B (n=74). After APC, all patients were given acid suppression therapy with omeprazole infusion 40 mg twice daily for 7 days, then omeprazole capsules 20 mg twice a day orally, the overall time was 2months. The patients in infection group B received Hp eradication therapy with two of the following three kinds of antibiotics for 2 weeks amoxicillin 500 mg twice a day, clarithromycin 500 mg twice a day and tinidazole 500 mg twice a day. All patients received reexamination of endoscopy and pathology, and underwent 24-hour esophageal pH test 1, 3, 6, 12 and 24 months after treatment.Results By APC treatment for an average of 2.4 times (1-3 times), 1 month after treatment, all BE epithelium disappeared and stratified squamous epithelium was repaired completely. Reflux esophagitis (RE) and BE in some cases were found in 3 groups 3 months after therapy. The relapse incidence of RE was significantly increased at 6 months after therapy [control group 22.6%, infection group A12.2o%and infection group B 17. 6%, t = 2.21, 2.17 and 2.30,P＜0. 05]. At 12 months after therapy, the relapse incidence of BE was significantly increased [control group 22.6%, infection group A 18.9% and infection group B 23.0%, t=2.11, 2.19 and 2.32, P＜0. 05]. All patients presented pathological gastro-esophageal reflux (DeMeester index＞14.72) before treatment. At 1 month after therapy, all patients returned to normal DeMeester index[control group 14.5, infection group A 15.2 and infection group B 12.0, t=2.09, 2.22 and 2.15, P＜0. 05]. At 6 months after treatment, DeMeester index increased (t=2.29, 2.33 and 2.14, P＜0.05). But there were no significant differences among 3 groups (P＞0. 05). Conclusions The elderly BE patients with HP infection in gastric antrum can receive APC treatment plus Hp eradication treatment, but it has no significant effect on long-term prognosis for BE patients. APC treatment can completely remove BE epithelium, long-term acid suppression therapy may delay recurrence of BE.