Clinical Significance Of Helicobacter Pylori Eradication In Patients With Chronic Atrophic Gastritis

BackgroundGastric cancer is one of the leading causes of death in the world and ranks third among malignant tumors.With the continuous increase of the population and the aging of the population,new cases and deaths are expected to continue to rise.There is evidence that Helicobacter pylori(Helicobacter pylori,H.pylori)infection in the stomach can cause gastric cancer.The cascade reaction after Hp infection proposed by Correa has been generally accepted by experts and scholars,that is,the development model of normal gastric mucosa-superficial gastritis-chronic atrophic gastritis(Chronic Atrophic Gastritis,CAG)/intestinal metaplasia(Intestinal Metaplasia,IM)-dysplasia(intraepithelial neoplasia)-intestinal type gastric cancer.Hp is one of the most prevalent infectious diseases in the world.About 50%of the people in the world are infected with Hp.China is also a country with high infection rate of Hp and high incidence of gastric cancer.Chronic atrophic gastritis and intestinal metaplasia are usually closely related to Hp infection.Both of them are risk factors of gastric cancer and are clear precancerous state.Hp infection is an initiating factor in the occurrence and development of gastric cancer,and the persistence of infection is an important etiology and developmental factor of CAG and IM.For Hp-associated atrophic gastritis,early diagnosis,early treatment and regular reexamination can effectively reduce the incidence and mortality of gastric cancer.A lot of research data shows that eradication therapy of Hp infection can significantly reduce the degree of inflammation and atrophy of gastric mucosa,but there is still controversy about whether eradication of Hp can improve intestinal metaplasia,reverse precancerous lesions such as gastric mucosal atrophy and intestinal metaplasia,and prevent precancerous lesions from progressing to gastric cancer.We aim at exploring the clinical significance of Hp eradication therapy in patients with chronic atrophic gastritis,through comparing the changes of three aspects(including clinical symptoms,gastroscopy and pathological manifestations)before and after eradication.ObjectiveThe purpose of this study is to explore the benefits of Hp eradication therapy on patients with chronic atrophic gastritis in terms of clinical symptoms,gastroscopic and pathological manifestations.The study makes patients pay more attention to the prevention of gastric cancer,helping them understand the negative effect of Hp infection.Therefore,we can improve the prevention and treatment of gastric cancer.MethodsPatients with chronic atrophic gastritis in Qilu Hospital of Shandong University from January 2017 to January 2019 were divided into Hp positive group and Hp negative group according to the results of Hp,and the clinical symptoms,gastroscopic and pathological manifestations were scored.Then the Hp positive group was treated with amoxicillin,clarithromycin,rabeprazole and colloidal bismuth pectin for 14 days,and 13C breath test was performed after 4 weeks' withdrawal.The patients in the two groups were followed up for about 1 year and received health education and psychological counseling.One year later,the clinical manifestations,gastroscopic manifestations and pathological manifestations were scored again,and the data before and after eradication were statistically analyzed.Results1.In Hp positive group,the eradication rate was 89.0%(81/91),and no obvious adverse drug reactions occurred during the eradication treatment.The recurrence rate within one year was 4.9%(4/81).2.After 1-year follow-up,many clinical symptoms such as epigastric pain,abdominal distension,acid regurgitation and heartburn were relieved in Hp successful eradication group.The scores of epigastric pain and abdominal distension decreased from 2.40±1.14to 1.67±0.83(P=0.000)and from 1.94±0.97to 1.48±0.87(P=0.011)respectively.However,there was no significant relief of symptoms in Hp persistent positive group and Hp negative group.3.After follow-up,there was no improvement in gastroscopic mucosal morphology in Hp successful eradication group,Hp persistent positive group and Hp negative group,while the scores of each group increased in varying degrees.4.In Hp successful eradication group,the scores of chronic inflammation and activity decreased significantly after follow-up(the scores of chronic inflammation score decreased from 2.06±0.74 to 1.45±0.68(P=0.000),the scores of activity score decreased from 1.45±0.85 to 0.94±0.78(P=0.000)),atrophic scores decreased slightly(from 1.76±0.95 to 1.63±0.81,P=0.259),furthermore,a small number of patients may have a reversal of atrophy,but the score of intestinal metaplasia did not decrease significantly.The scores of chronic inflammation,activity,atrophy and intestinal metaplasia of gastric mucosa in Hp persistent positive group were higher than those at the beginning,while there was no change in the four histological pathological scores in the Hp negative group after 1 year later.Conclusions1.The 14-day regimen of colloidal bismuth pectin?rabeprazole+amoxicillin+clarithromycin has high eradication rate and few adverse reactions,so it is a recommended first-line eradication regimen.2.Many clinical symptoms of patients with chronic atrophic gastritis were improved after successful eradication of Hp,which is of great clinical significance to the improvement of patients' quality of life.3.Gastroscopy is one of the important examination methods for chronic atrophic gastritis.The mucosa did not improve within 1 year after eradication treatment.Histopathology should be combined with in the evaluation of the disease4.After Hp eradication treatment,chronic inflammation and activity of gastric mucosa in patients with chronic atrophic gastritis were significantly improved,atrophy was slightly improved,but there was no improvement on intestinal metaplasia.The persistent existence of Hp can aggravate mucosal inflammation,atrophy and intestinal metaplasia.5.For patients with chronic atrophic gastritis,while giving drug treatment,we should pay attention to health education and psychological counseling,and suggest that patients should be followed up regularly by endoscopy and pathology.