Five-year follow-up study on histological and endoscopic alterations in the gastric mucosa after Helicobacter pylori eradication

Background:  To investigate long-term changes in the gastric mucosa after Helicobacter pylori eradication, we examined histological and endoscopic findings of the gastric mucosa before and 5 years after eradication. Methods:  The subjects comprised 59 H. pylori-positive patients with peptic ulcer who had been periodically followed for 5 years after H. pylori eradication. Acid-suppressive drugs were not given after eradication, and endoscopic examination and tests for H. pylori infection (urea breath test (UBT), culture and histology) were performed before and 1 to 2 months, 1 year, and 5 years after eradication. Biopsy samples were taken from the greater curvature of the gastric antrum and upper corpus, and were scored histologically according to the Updated Sydney System. The atrophic border was evaluated endoscopically based on Kimura and Takemoto's classification. Antral erosion and spotty redness in the corpus were also scored. Results:  (1) Neutrophil infiltration was significantly reduced 1 to 2 months after eradication and remained around the reduced level over the next 5 years. Mononuclear cell infiltration began to decrease 1 to 2 months after eradication and continued to subside 1 year and 5 years later. (2) Histological atrophy of the gastric glands was significantly improved 1 year and 5 years after eradication. However, endoscopy revealed no consistent alteration in the atrophic border. (3) There was no significant change in the degree of intestinal metaplasia for 5 years. (4) In some cases, antral erosion became more conspicuous after 5 years. Spotty redness in the corpus was observed in 15% of cases (9/59) before and 10% (6/59) 1 year after eradication, but had disappeared in all cases 5 years later. Conclusions:  Neutrophil infiltration improved rapidly after H. pylori eradication in contrast with mononuclear cell infiltration, which decreased gradually over 5 years. Glandular atrophy improved in the long term, whereas intestinal metaplasia had not altered 5 years after eradication. Spotty redness in the gastric corpus disappeared in all cases after eradication, suggesting that it is an endoscopic finding related to H. pylori infection.