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The Difference of Endoscopic and Histologic Improvements of Atrophic Gastritis and Intestinal Metaplasia After Helicobacter pylori Eradication

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Abstract

Background/Aims

Helicobacter pylori (H. pylori) is an important risk factor of atrophic gastritis (AG), intestinal metaplasia (IM), and gastric cancer (GC). However, no report to date has described the endoscopic improvement of AG and IM after H. pylori eradication. Thus, the aim of this study was to evaluate the improvement of AG and IM after H. pylori eradication using endoscopic and histologic analyses.

Methods

A total of 380 subjects were prospectively enrolled for up to 12 years and grouped by their H. pylori infection status: negative, non-eradicated, and eradicated. Endoscopic and histologic analyses of AG and IM were performed in the antrum and the corpus, by annual follow-up endoscopy.

Results

Endoscopic AG and IM in the antrum and corpus in the eradicated group improved compared to that in the non-eradicated group (AG, P = 0.002 and P = 0.005; IM, P = 0.038 and P = 0.048, respectively). Histologic AG and IM in the antrum and corpus in the eradicated group also improved compared to that in the non-eradicated group (all P < 0.001). Time taken to the endoscopic improvement of AG and IM after H. pylori eradication was significantly longer than time taken to the histologic improvement in the antrum and corpus (AG in antrum: 3.47 ± 2.60 vs. 2.34 ± 1.71 years, P = 0.004; AG in corpus: 3.19 ± 2.30 vs. 1.87 ± 1.48 years, P = 0.002; IM in antrum: 4.40 ± 2.38 vs. 3.62 ± 2.35 years, P = 0.043; and IM in corpus: 4.82 ± 1.08 vs. 3.61 ± 2.22 years, P = 0.007, respectively).

Conclusions

Both endoscopic and histologic improvements of AG and IM were observed after H. pylori eradication, while endoscopic improvement took significantly longer time than histologic improvement.

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Abbreviations

H. pylori :

Helicobacter pylori

AG:

Atrophic gastritis

IM:

Intestinal metaplasia

GC:

Gastric cancer

CLO:

Campylobacter-like organism

PPV:

Positive predictive values

NPV:

Negative predictive values

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant for the Global Core Research Center (GCRC), funded by the Korean government (MSIP) (No. 2011-0030001).

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Author notes

  1. Young Jae Hwang and Yonghoon Choi have contributed equally to this work.

Authors and Affiliations

  1. Digestive Disease Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Young Jae Hwang, Yonghoon Choi, Nayoung Kim, Hyuk Yoon, Cheol Min Shin, Young Soo Park & Dong Ho Lee

  2. Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Hye Seung Lee

  3. Department of Internal Medicine and Institute of Liver Research, Seoul National University College of Medicine, Seoul, South Korea

    Nayoung Kim & Dong Ho Lee

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  1. Young Jae Hwang
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Contributions

Y.J.H analyzed the data, performed interpretation of the data, drafted the article, performed statistical analyses, and decided whether AG and IM were improved in each patient; Y.C analyzed the data, performed interpretation of the data, and critically revised this manuscript for revision. N.K. designed and concept the protocol, enrolled the participants, collected the data and substantially edited the manuscript; H.S.L. performed the pathologic diagnosis of Sydney classification for tissue which had been taken from the antrum and corpus; and H.Y., C.M.S, Y.S.P, and D.H.L. interpreted the data and performed critical revision of the article for important intellectual content; all authors have read and approved the final approval of this paper.

Corresponding author

Correspondence to Nayoung Kim.

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Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Declaration of Helsinki, and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants in this study.

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Supplementary Information

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Supplementary Figure 1

Endoscopic biopsy sites in the stomach. (A) 10 endoscopic biopsy sites on baseline. (B) 4 endoscopic biopsy sites on the follow-up. Supplementary Figure 2 Grades of atrophic gastritis (AG) and intestinal metaplasia (IM). (A) Grades of AG and IM in the antrum. (B) Grades of AG and IM in the corpus. Supplementary Figure 3 The definition of the improvement of atrophic gastritis (AG). We defined the endoscopic improvement of AG as a continuous reduction in the area of atrophic change during follow-up, from diffuse (open) to focal (closed) type with Kimura-Takemoto classification (arrow). Supplementary Figure 4 Cases of the endoscopic improvement in atrophic gastritis (AG) and intestinal metaplasia (IM) before and after Helicobacter pylori eradication. (A-1) Antral AG (O-1 type) at baseline. A whitish mucosal color change was detected. (A-2) Improvement in antral AG (no atrophy) at 9 years after H. pylori eradication. The mucosal color change was regressed. (B-1) Corpus AG (O-2 type) at baseline. Well-visualized submucosal vessel on the corpus is seen. (B-2) Improvement in corpus AG (no atrophy) at 8 years after H. pylori eradication. The well-visualized submucosal vessel on the corpus had regressed. (C-1) Antral IM (grade: 2) at baseline. A villous-appearing mucosal elevation on the antrum is visible. (C-2) Improvement in antral IM (grade: 0) 8 years after H. pylori eradication. The villous-appearing mucosal elevation on the antrum has regressed. A villous-appearing mucosal elevation on the corpus is visible. (D-1) Corpus IM (grade: 2) at baseline. (D-2) Improvement in corpus IM (grade: 0) 5 years after H. pylori eradication. The villous-appearing mucosal elevation on the corpus has regressed (PPTX 798 kb)

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Hwang, Y.J., Choi, Y., Kim, N. et al. The Difference of Endoscopic and Histologic Improvements of Atrophic Gastritis and Intestinal Metaplasia After Helicobacter pylori Eradication. Dig Dis Sci 67, 3055–3066 (2022). https://doi.org/10.1007/s10620-021-07146-4

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