| Objective:To evaluate the effect of combination therapy with hydrotalcite and folic acid on the treatment of chronic atrophic gastritis (CAG).Methods:From August 2009 to August 2010, twenty patients with CAG were enrolled from the outpatient department of Sir Run Run Shaw Hospital. All patients were diagnosed as CAG by both endoscopic and pathologic findings. The patients with Helicobactor pylori (Hp) infection were successful eradicated, followed by a one-week wash-out period, and then assigned into the treatment group and control group respectively. In the treatment group (n=12), patients were received hydrosulfite (1g, t.i.d, p.o) combined with folic acid (10 mg, t.i.d, p.o) for 3 months, while the control group (n=8) were received consent and monitored with endoscopic surveillance at the end of 3 months without receiving medication. A self-administered questionnaire survey was conducted to evaluate the clinical dyspepsia symptoms (including abdominal pain, anorexia, acid regurgitation, abdominal distension, belching, nausea and vomiting) before and after the treatment. Marking targeting biopsy was performed and the pathological finding of the biopsies specimens obtained from the same site of the stomach was analyzed after 3 months. The pathological severity of glandular atrophy and intestinal metaplasia (IM) was scored from 0 (normal) to 3 (markedly abnormal) according to the visual analogue scales of the updated Sydney System. The pathological sum score were obtained from the above atrophic and IM respectively. We defined the pathological efficacy of the treatment in both two groups using the following criteria: reversibility, defined as a more than 1 score reduction from baseline in the pathological score; stable, defined as no change of the pathological score; progression, defined as a more than 1 score increase from baseline in the pathological score. The statistical analysis was performed.Results:Before the enrollment,2 of 12 cases showed Hp infection in the treatment group, while 3 of 8 cases with Hp infection in the control group. All patients were successfully received Hp eradiation therapy. Clinical dyspepsia symptoms score in the treatment group were decreased to 3.67±1.72 when compared to 2.33±1.44 in enrollment (P=0.014). The score in the control group decreased from 4.88±2.53 to 2.62±2.56 (P=0.041). But there was no significant difference in dyspepsia symptoms score between the two groups (P=0.678). Among the treatment group (n=12), the reversing rate, stable rate and progression rate of atrophy were 33.3%(4/12),41.7% (5/12) and 25.0%(3/12), respectively. And the reversing rate, stable rate and progression rate of IM in the treatment group were 33.3%(4/12),58.3%(7/12)and 8.3% (1/12).respectively. While among the control group (n=8), the reversing rate, stable rate and progression rate of atrophy were 25.0%(2/8),12.5%(1/8) and 62.5%(5/8), respectively. And the reversing rate, stable rate and progression rate of IM in the control group were 25.0%(2/8),62.5%(5/8) and 12.5%(1/8).respectively. There were no significant differences both in the atrophy and IM lesion improvement between the two group (P=0.392,0.851).Considering both atrophy and IM by the pathological sum score, the reversing rate, stable rate and progression rate of tissue pathology in the treatment group were 50.0%(6/12),41.7%(5/12) and 12.5%(1/12), respectively. And the reversing rate, stable rate and progression rate of tissue pathology in the treatment group were 25.0%(2/8),25.0%(4/8) and 50.0%(4/8).respectively. Compared to the control group, the treatment group showed a better effect on improvement of tissue pathology than the control group, but with no significant difference (P=0.08).Conclusion:After an effectively eradication of Hp infection, the clinical dyspepsia symptoms in the CAG patients could be relieved, and the progression of atrophy and IM could be reduced or even reversed. The combination therapy with hydrotalcite and folic acid produces no additional benefit in terms of symptom relief in the successfully HP-eradicated CAG patients, but may have an additional benefit in regression of atrophy and IM.
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