Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial
Identifieur interne : 001B45 ( Istex/Corpus ); précédent : 001B44; suivant : 001B46Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial
Auteurs : E J Kuipers ; G F Nelis ; E C Klinkenberg-Knol ; P. Snel ; D. Goldfain ; J J Kolkman ; H P M. Festen ; J. Dent ; P. Zeitoun ; N. Havu ; M. Lamm ; A. WalanSource :
- Gut [ 0017-5749 ] ; 2004-01.
English descriptors
- KwdEn :
- Aliment, Aliment pharmacol, Antral, Antrum, Atrophic gastritis, Atrophy, Baseline, Biopsy, Centre, Corpus, Corpus gastritis activity, Endoscopy, Eradication, GORD, gastro-oesophageal reflux disease, Gastric, Gastric atrophy, Gastric cancer, Gastritis, Gastroenterol, Gastroenterology, Glandular, Glandular atrophy, Gord, Gord patients, Helicobacter, Helicobacter pylori, Helicobacter pylori eradication, Helicobacter pylori gastritis, Helicobacter pylori infection, Histological, Histological characteristics, Hopital, Hyperplasia, Inflammation, Inflammation atrophy, Intestinal, Intestinal metaplasia, Kuiper, Last visit, Metaplasia, Nelis, OAC, omeprazole, amoxycillin, clarithromycin, OM, omeprazole, OMC, omeprazole, metronidazole, clarithromycin, Oesophagitis, Omeprazole, Omeprazole dose, Omeprazole maintenance therapy, PPI, proton pump inhibitor, Pharmacol, Present study, Pylori density, Pylori eradication, Pylori eradication therapy, Pylori infection, Pylori status, Pylorus, Randomised, Rectal ulcer, Reflux, Reflux disease, Reflux oesophagitis, Reflux symptoms, Treatment group, Triple, Triple group, Triple groups, Value activity none, Variable score baseline, Visit baseline, atrophy, gastric cancer, gastritis, gastro-oesophageal reflux disease, omeprazole, randomised controlled trial.
- Teeft :
- Aliment, Aliment pharmacol, Antral, Antrum, Atrophic gastritis, Atrophy, Baseline, Biopsy, Centre, Corpus, Corpus gastritis activity, Endoscopy, Eradication, Gastric, Gastric atrophy, Gastric cancer, Gastritis, Gastroenterol, Gastroenterology, Glandular, Glandular atrophy, Gord, Gord patients, Helicobacter, Helicobacter pylori, Helicobacter pylori eradication, Helicobacter pylori gastritis, Helicobacter pylori infection, Histological, Histological characteristics, Hopital, Hyperplasia, Inflammation, Inflammation atrophy, Intestinal, Intestinal metaplasia, Kuiper, Last visit, Metaplasia, Nelis, Oesophagitis, Omeprazole, Omeprazole dose, Omeprazole maintenance therapy, Pharmacol, Present study, Pylori density, Pylori eradication, Pylori eradication therapy, Pylori infection, Pylori status, Pylorus, Randomised, Rectal ulcer, Reflux, Reflux disease, Reflux oesophagitis, Reflux symptoms, Treatment group, Triple, Triple group, Triple groups, Value activity none, Variable score baseline, Visit baseline.
Abstract
Background:Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective randomised study aimed to investigate whether H pylori eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastro-oesophageal reflux disease (GORD). Methods: A total of 231 H pylori positive GORD patients who had been treated for ⩾12 months with omeprazole maintenance therapy (OM) were randomised to either continuation of OM (OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and H pylori density. Results: Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, H pylori was eradicated in 90 (88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus (p<0.001, baseline v two years). Atrophic gastritis also improved in the corpus (p<0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased (p<0.01). H pylori eradication did not alter the dose of omeprazole required, or reflux symptoms. Conclusions: Most H pylori positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of H pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. H pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of H pylori in GORD patients receiving long term acid suppression.
Url:
DOI: 10.1136/gut.53.1.12
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ISTEX:90ECB6E19A2425EA04D2907BFE3DB28A49D281AELe document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</title><author><name sortKey="Kuipers, E J" sort="Kuipers, E J" uniqKey="Kuipers E" first="E J" last="Kuipers">E J Kuipers</name><affiliation><mods:affiliation>Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Nelis, G F" sort="Nelis, G F" uniqKey="Nelis G" first="G F" last="Nelis">G F Nelis</name><affiliation><mods:affiliation>Department of Gastroenterology, Sophia Hospital, Zwolle, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Klinkenberg Knol, E C" sort="Klinkenberg Knol, E C" uniqKey="Klinkenberg Knol E" first="E C" last="Klinkenberg-Knol">E C Klinkenberg-Knol</name><affiliation><mods:affiliation>Department of Gastroenterology, Free University Hospital, Amsterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Snel, P" sort="Snel, P" uniqKey="Snel P" first="P" last="Snel">P. Snel</name><affiliation><mods:affiliation>Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Goldfain, D" sort="Goldfain, D" uniqKey="Goldfain D" first="D" last="Goldfain">D. Goldfain</name><affiliation><mods:affiliation>Department of Gastroenterology, Hopital Victor Jusselin, Dreux, France</mods:affiliation></affiliation></author><author><name sortKey="Kolkman, J J" sort="Kolkman, J J" uniqKey="Kolkman J" first="J J" last="Kolkman">J J Kolkman</name><affiliation><mods:affiliation>Department of Gastroenterology, Medical Spectrum Twente, Enschede, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Festen, H P M" sort="Festen, H P M" uniqKey="Festen H" first="H P M" last="Festen">H P M. Festen</name><affiliation><mods:affiliation>Department of Gastroenterology, Groot Ziekengasthuis, Den Bosch, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Dent, J" sort="Dent, J" uniqKey="Dent J" first="J" last="Dent">J. Dent</name><affiliation><mods:affiliation>Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia</mods:affiliation></affiliation></author><author><name sortKey="Zeitoun, P" sort="Zeitoun, P" uniqKey="Zeitoun P" first="P" last="Zeitoun">P. Zeitoun</name><affiliation><mods:affiliation>Department of Gastroenterology, Hopital Robert Derbre, Reims, France</mods:affiliation></affiliation></author><author><name sortKey="Havu, N" sort="Havu, N" uniqKey="Havu N" first="N" last="Havu">N. Havu</name><affiliation><mods:affiliation>AstraZeneca R&D, Södertalje, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Lamm, M" sort="Lamm, M" uniqKey="Lamm M" first="M" last="Lamm">M. Lamm</name><affiliation><mods:affiliation>AstraZeneca R&D, Mölndal, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Walan, A" sort="Walan, A" uniqKey="Walan A" first="A" last="Walan">A. Walan</name><affiliation><mods:affiliation>AstraZeneca R&D, Mölndal, Sweden</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:90ECB6E19A2425EA04D2907BFE3DB28A49D281AE</idno><date when="2004" year="2004">2004</date><idno type="doi">10.1136/gut.53.1.12</idno><idno type="url">https://api.istex.fr/document/90ECB6E19A2425EA04D2907BFE3DB28A49D281AE/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001B45</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001B45</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</title><author><name sortKey="Kuipers, E J" sort="Kuipers, E J" uniqKey="Kuipers E" first="E J" last="Kuipers">E J Kuipers</name><affiliation><mods:affiliation>Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Nelis, G F" sort="Nelis, G F" uniqKey="Nelis G" first="G F" last="Nelis">G F Nelis</name><affiliation><mods:affiliation>Department of Gastroenterology, Sophia Hospital, Zwolle, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Klinkenberg Knol, E C" sort="Klinkenberg Knol, E C" uniqKey="Klinkenberg Knol E" first="E C" last="Klinkenberg-Knol">E C Klinkenberg-Knol</name><affiliation><mods:affiliation>Department of Gastroenterology, Free University Hospital, Amsterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Snel, P" sort="Snel, P" uniqKey="Snel P" first="P" last="Snel">P. Snel</name><affiliation><mods:affiliation>Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Goldfain, D" sort="Goldfain, D" uniqKey="Goldfain D" first="D" last="Goldfain">D. Goldfain</name><affiliation><mods:affiliation>Department of Gastroenterology, Hopital Victor Jusselin, Dreux, France</mods:affiliation></affiliation></author><author><name sortKey="Kolkman, J J" sort="Kolkman, J J" uniqKey="Kolkman J" first="J J" last="Kolkman">J J Kolkman</name><affiliation><mods:affiliation>Department of Gastroenterology, Medical Spectrum Twente, Enschede, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Festen, H P M" sort="Festen, H P M" uniqKey="Festen H" first="H P M" last="Festen">H P M. Festen</name><affiliation><mods:affiliation>Department of Gastroenterology, Groot Ziekengasthuis, Den Bosch, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Dent, J" sort="Dent, J" uniqKey="Dent J" first="J" last="Dent">J. Dent</name><affiliation><mods:affiliation>Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia</mods:affiliation></affiliation></author><author><name sortKey="Zeitoun, P" sort="Zeitoun, P" uniqKey="Zeitoun P" first="P" last="Zeitoun">P. Zeitoun</name><affiliation><mods:affiliation>Department of Gastroenterology, Hopital Robert Derbre, Reims, France</mods:affiliation></affiliation></author><author><name sortKey="Havu, N" sort="Havu, N" uniqKey="Havu N" first="N" last="Havu">N. Havu</name><affiliation><mods:affiliation>AstraZeneca R&D, Södertalje, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Lamm, M" sort="Lamm, M" uniqKey="Lamm M" first="M" last="Lamm">M. Lamm</name><affiliation><mods:affiliation>AstraZeneca R&D, Mölndal, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Walan, A" sort="Walan, A" uniqKey="Walan A" first="A" last="Walan">A. Walan</name><affiliation><mods:affiliation>AstraZeneca R&D, Mölndal, Sweden</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Gut</title><title level="j" type="abbrev">Gut</title><idno type="ISSN">0017-5749</idno><idno type="eISSN">1468-3288</idno><imprint><publisher>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><date type="published" when="2004-01">2004-01</date><biblScope unit="volume">53</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="12">12</biblScope></imprint><idno type="ISSN">0017-5749</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0017-5749</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aliment</term><term>Aliment pharmacol</term><term>Antral</term><term>Antrum</term><term>Atrophic gastritis</term><term>Atrophy</term><term>Baseline</term><term>Biopsy</term><term>Centre</term><term>Corpus</term><term>Corpus gastritis activity</term><term>Endoscopy</term><term>Eradication</term><term>GORD, gastro-oesophageal reflux disease</term><term>Gastric</term><term>Gastric atrophy</term><term>Gastric cancer</term><term>Gastritis</term><term>Gastroenterol</term><term>Gastroenterology</term><term>Glandular</term><term>Glandular atrophy</term><term>Gord</term><term>Gord patients</term><term>Helicobacter</term><term>Helicobacter pylori</term><term>Helicobacter pylori eradication</term><term>Helicobacter pylori gastritis</term><term>Helicobacter pylori infection</term><term>Histological</term><term>Histological characteristics</term><term>Hopital</term><term>Hyperplasia</term><term>Inflammation</term><term>Inflammation atrophy</term><term>Intestinal</term><term>Intestinal metaplasia</term><term>Kuiper</term><term>Last visit</term><term>Metaplasia</term><term>Nelis</term><term>OAC, omeprazole, amoxycillin, clarithromycin</term><term>OM, omeprazole</term><term>OMC, omeprazole, metronidazole, clarithromycin</term><term>Oesophagitis</term><term>Omeprazole</term><term>Omeprazole dose</term><term>Omeprazole maintenance therapy</term><term>PPI, proton pump inhibitor</term><term>Pharmacol</term><term>Present study</term><term>Pylori density</term><term>Pylori eradication</term><term>Pylori eradication therapy</term><term>Pylori infection</term><term>Pylori status</term><term>Pylorus</term><term>Randomised</term><term>Rectal ulcer</term><term>Reflux</term><term>Reflux disease</term><term>Reflux oesophagitis</term><term>Reflux symptoms</term><term>Treatment group</term><term>Triple</term><term>Triple group</term><term>Triple groups</term><term>Value activity none</term><term>Variable score baseline</term><term>Visit baseline</term><term>atrophy</term><term>gastric cancer</term><term>gastritis</term><term>gastro-oesophageal reflux disease</term><term>omeprazole</term><term>randomised controlled trial</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Aliment</term><term>Aliment pharmacol</term><term>Antral</term><term>Antrum</term><term>Atrophic gastritis</term><term>Atrophy</term><term>Baseline</term><term>Biopsy</term><term>Centre</term><term>Corpus</term><term>Corpus gastritis activity</term><term>Endoscopy</term><term>Eradication</term><term>Gastric</term><term>Gastric atrophy</term><term>Gastric cancer</term><term>Gastritis</term><term>Gastroenterol</term><term>Gastroenterology</term><term>Glandular</term><term>Glandular atrophy</term><term>Gord</term><term>Gord patients</term><term>Helicobacter</term><term>Helicobacter pylori</term><term>Helicobacter pylori eradication</term><term>Helicobacter pylori gastritis</term><term>Helicobacter pylori infection</term><term>Histological</term><term>Histological characteristics</term><term>Hopital</term><term>Hyperplasia</term><term>Inflammation</term><term>Inflammation atrophy</term><term>Intestinal</term><term>Intestinal metaplasia</term><term>Kuiper</term><term>Last visit</term><term>Metaplasia</term><term>Nelis</term><term>Oesophagitis</term><term>Omeprazole</term><term>Omeprazole dose</term><term>Omeprazole maintenance therapy</term><term>Pharmacol</term><term>Present study</term><term>Pylori density</term><term>Pylori eradication</term><term>Pylori eradication therapy</term><term>Pylori infection</term><term>Pylori status</term><term>Pylorus</term><term>Randomised</term><term>Rectal ulcer</term><term>Reflux</term><term>Reflux disease</term><term>Reflux oesophagitis</term><term>Reflux symptoms</term><term>Treatment group</term><term>Triple</term><term>Triple group</term><term>Triple groups</term><term>Value activity none</term><term>Variable score baseline</term><term>Visit baseline</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background:Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective randomised study aimed to investigate whether H pylori eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastro-oesophageal reflux disease (GORD). Methods: A total of 231 H pylori positive GORD patients who had been treated for ⩾12 months with omeprazole maintenance therapy (OM) were randomised to either continuation of OM (OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and H pylori density. Results: Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, H pylori was eradicated in 90 (88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus (p<0.001, baseline v two years). Atrophic gastritis also improved in the corpus (p<0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased (p<0.01). H pylori eradication did not alter the dose of omeprazole required, or reflux symptoms. Conclusions: Most H pylori positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of H pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. H pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of H pylori in GORD patients receiving long term acid suppression.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>pylorus</json:string><json:string>gastritis</json:string><json:string>omeprazole</json:string><json:string>reflux</json:string><json:string>helicobacter</json:string><json:string>gastric</json:string><json:string>baseline</json:string><json:string>pylori eradication</json:string><json:string>metaplasia</json:string><json:string>reflux disease</json:string><json:string>gastroenterology</json:string><json:string>kuiper</json:string><json:string>randomised</json:string><json:string>triple group</json:string><json:string>oesophagitis</json:string><json:string>atrophic gastritis</json:string><json:string>intestinal</json:string><json:string>helicobacter pylori</json:string><json:string>intestinal metaplasia</json:string><json:string>antral</json:string><json:string>glandular atrophy</json:string><json:string>helicobacter pylori eradication</json:string><json:string>hopital</json:string><json:string>pylori infection</json:string><json:string>pharmacol</json:string><json:string>aliment</json:string><json:string>endoscopy</json:string><json:string>eradication</json:string><json:string>histological</json:string><json:string>reflux oesophagitis</json:string><json:string>nelis</json:string><json:string>helicobacter pylori infection</json:string><json:string>antrum</json:string><json:string>aliment pharmacol</json:string><json:string>gastroenterol</json:string><json:string>gord patients</json:string><json:string>last visit</json:string><json:string>inflammation</json:string><json:string>atrophy</json:string><json:string>pylori status</json:string><json:string>present study</json:string><json:string>gord</json:string><json:string>glandular</json:string><json:string>corpus gastritis activity</json:string><json:string>treatment group</json:string><json:string>reflux symptoms</json:string><json:string>gastric cancer</json:string><json:string>triple</json:string><json:string>omeprazole dose</json:string><json:string>helicobacter pylori gastritis</json:string><json:string>histological characteristics</json:string><json:string>triple groups</json:string><json:string>variable score baseline</json:string><json:string>visit baseline</json:string><json:string>value activity none</json:string><json:string>inflammation atrophy</json:string><json:string>pylori eradication therapy</json:string><json:string>omeprazole maintenance therapy</json:string><json:string>gastric atrophy</json:string><json:string>pylori density</json:string><json:string>rectal ulcer</json:string><json:string>centre</json:string><json:string>hyperplasia</json:string><json:string>biopsy</json:string><json:string>corpus</json:string><json:string>first week</json:string><json:string>gastric mucosa</json:string><json:string>actual numbers</json:string><json:string>acid suppressive therapy</json:string><json:string>long term</json:string><json:string>corpus gastritis</json:string><json:string>oesophageal acid exposure</json:string><json:string>long term acid suppression</json:string><json:string>isala klinieken</json:string><json:string>gland loss</json:string><json:string>triple patients</json:string><json:string>triple figure</json:string><json:string>eradication therapy</json:string><json:string>normal activities</json:string><json:string>omeprazole therapy</json:string><json:string>acid suppression</json:string><json:string>previous studies</json:string></teeft></keywords><author><json:item><name>E J Kuipers</name><affiliations><json:string>Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands</json:string></affiliations></json:item><json:item><name>G F Nelis</name><affiliations><json:string>Department of Gastroenterology, Sophia Hospital, Zwolle, the Netherlands</json:string></affiliations></json:item><json:item><name>E C Klinkenberg-Knol</name><affiliations><json:string>Department of Gastroenterology, Free University Hospital, Amsterdam, the Netherlands</json:string></affiliations></json:item><json:item><name>P Snel</name><affiliations><json:string>Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands</json:string></affiliations></json:item><json:item><name>D Goldfain</name><affiliations><json:string>Department of Gastroenterology, Hopital Victor Jusselin, Dreux, France</json:string></affiliations></json:item><json:item><name>J J Kolkman</name><affiliations><json:string>Department of Gastroenterology, Medical Spectrum Twente, Enschede, the Netherlands</json:string></affiliations></json:item><json:item><name>H P M Festen</name><affiliations><json:string>Department of Gastroenterology, Groot Ziekengasthuis, Den Bosch, the Netherlands</json:string></affiliations></json:item><json:item><name>J Dent</name><affiliations><json:string>Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia</json:string></affiliations></json:item><json:item><name>P Zeitoun</name><affiliations><json:string>Department of Gastroenterology, Hopital Robert Derbre, Reims, France</json:string></affiliations></json:item><json:item><name>N Havu</name><affiliations><json:string>AstraZeneca R&D, Södertalje, Sweden</json:string></affiliations></json:item><json:item><name>M Lamm</name><affiliations><json:string>AstraZeneca R&D, Mölndal, Sweden</json:string></affiliations></json:item><json:item><name>A Walan</name><affiliations><json:string>AstraZeneca R&D, Mölndal, Sweden</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Helicobacter pylori</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gastro-oesophageal reflux disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gastritis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>atrophy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gastric cancer</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>omeprazole</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>randomised controlled trial</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>GORD, gastro-oesophageal reflux disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PPI, proton pump inhibitor</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>OM, omeprazole</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>OAC, omeprazole, amoxycillin, clarithromycin</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>OMC, omeprazole, metronidazole, clarithromycin</value></json:item></subject><arkIstex>ark:/67375/NVC-98K7X1MZ-P</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>other</json:string></originalGenre><abstract>Background:Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective randomised study aimed to investigate whether H pylori eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastro-oesophageal reflux disease (GORD). Methods: A total of 231 H pylori positive GORD patients who had been treated for ⩾12 months with omeprazole maintenance therapy (OM) were randomised to either continuation of OM (OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and H pylori density. Results: Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, H pylori was eradicated in 90 (88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus (p>0.001, baseline v two years). Atrophic gastritis also improved in the corpus (p>0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased (p>0.01). H pylori eradication did not alter the dose of omeprazole required, or reflux symptoms. Conclusions: Most H pylori positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of H pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. H pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of H pylori in GORD patients receiving long term acid suppression.</abstract><qualityIndicators><score>10</score><pdfWordCount>6722</pdfWordCount><pdfCharCount>44297</pdfCharCount><pdfVersion>1.2</pdfVersion><pdfPageCount>9</pdfPageCount><pdfPageSize>611.433 x 790.583 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>313</abstractWordCount><abstractCharCount>2137</abstractCharCount><keywordCount>12</keywordCount></qualityIndicators><title>Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</title><pmid><json:string>14684569</json:string></pmid><genre><json:string>other</json:string></genre><host><title>Gut</title><language><json:string>unknown</json:string></language><issn><json:string>0017-5749</json:string></issn><eissn><json:string>1468-3288</json:string></eissn><volume>53</volume><issue>1</issue><pages><first>12</first></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Campylobacter, Salmonella, Shigella, Escherichia coli</value></json:item><json:item><value>Helicobacter pylori</value></json:item><json:item><value>Gastro-oesophageal reflux</value></json:item><json:item><value>Stomach and duodenum</value></json:item><json:item><value>Pancreatic cancer</value></json:item></subject></host><namedEntities><unitex><date><json:string>2003-12-18</json:string><json:string>1996</json:string></date><geogName></geogName><orgName><json:string>Australia Adelaide</json:string><json:string>Denmark Odense</json:string><json:string>Sweden Gavle</json:string><json:string>Department of Gastroenterology, Hopital Victor Jusselin, Dreux, France J J Kolkman, Department of Gastroenterology, Medical Spectrum Twente, Enschede, the Netherlands H P</json:string><json:string>Country Hospital Sandviken-Gavle</json:string><json:string>Free University</json:string><json:string>UK Leeds</json:string><json:string>France Creteil</json:string><json:string>Netherlands Amsterdam</json:string><json:string>Department of Gastroenterology, Groot Ziekengasthuis, Den Bosch, the Netherlands J Dent, Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia P Zeitoun, Department of Gastroenterology, Hopital Robert Derbre, Reims, France</json:string><json:string>US Food and Drug</json:string><json:string>Leiden University</json:string><json:string>Japan and Hong Kong</json:string><json:string>Department of Gastroenterology, Sophia Hospital, Zwolle, the Netherlands E</json:string><json:string>Department of Gastroenterology and Hepatology</json:string><json:string>Germany Fulda</json:string><json:string>Department of Gastroenterology, Free University Hospital, Amsterdam, the Netherlands P Snel, Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands</json:string><json:string>American Gastroenterology Association, Atlanta, Georgia</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Chu Bichat</json:string><json:string>Adelaide Hospital</json:string><json:string>Robert Debre</json:string><json:string>The</json:string><json:string>Patients</json:string><json:string>Informed</json:string><json:string>Min Max</json:string><json:string>Max Duration</json:string><json:string>Henri Mondor</json:string><json:string>I. Corpus</json:string><json:string>Albert Schweitzer</json:string><json:string>Charles Nicolle</json:string><json:string>Lundell</json:string><json:string>Marie Madeleine</json:string></persName><placeName><json:string>Bedford</json:string><json:string>Leiden</json:string><json:string>Haarlem</json:string><json:string>Enschede</json:string><json:string>Breda</json:string><json:string>Stoke-on-Trent</json:string><json:string>Reims</json:string><json:string>Nijmegen</json:string><json:string>Sheffield</json:string><json:string>Gothenburg</json:string><json:string>Toulouse</json:string><json:string>Rotterdam</json:string><json:string>St Radboud</json:string><json:string>Launceston</json:string><json:string>Sweden</json:string><json:string>Odense</json:string><json:string>Netherlands</json:string><json:string>Zwolle</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Solcia et al</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/NVC-98K7X1MZ-P</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - gastroenterology & hepatology</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - gastroenterology & hepatology</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Gastroenterology</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>2004</publicationDate><copyrightDate>2004</copyrightDate><doi><json:string>10.1136/gut.53.1.12</json:string></doi><id>90ECB6E19A2425EA04D2907BFE3DB28A49D281AE</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/90ECB6E19A2425EA04D2907BFE3DB28A49D281AE/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/90ECB6E19A2425EA04D2907BFE3DB28A49D281AE/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/90ECB6E19A2425EA04D2907BFE3DB28A49D281AE/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><availability><licence><p>Copyright 2004 by Gut</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</p></availability><date>2003-12-18</date></publicationStmt><notesStmt><note type="other" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-7474895G-0">other</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note><note>Correspondence to:
Professor E J Kuipers
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e.j.kuipers@erasmusmc.nl</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</title><author xml:id="author-0000"><persName><forename type="first">E J</forename><surname>Kuipers</surname></persName><affiliation>Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands</affiliation></author><author xml:id="author-0001"><persName><forename type="first">G F</forename><surname>Nelis</surname></persName><affiliation>Department of Gastroenterology, Sophia Hospital, Zwolle, the Netherlands</affiliation></author><author xml:id="author-0002"><persName><forename type="first">E C</forename><surname>Klinkenberg-Knol</surname></persName><affiliation>Department of Gastroenterology, Free University Hospital, Amsterdam, the Netherlands</affiliation></author><author xml:id="author-0003"><persName><forename type="first">P</forename><surname>Snel</surname></persName><affiliation>Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands</affiliation></author><author xml:id="author-0004"><persName><forename type="first">D</forename><surname>Goldfain</surname></persName><affiliation>Department of Gastroenterology, Hopital Victor Jusselin, Dreux, France</affiliation></author><author xml:id="author-0005"><persName><forename type="first">J J</forename><surname>Kolkman</surname></persName><affiliation>Department of Gastroenterology, Medical Spectrum Twente, Enschede, the Netherlands</affiliation></author><author xml:id="author-0006"><persName><forename type="first">H P M</forename><surname>Festen</surname></persName><affiliation>Department of Gastroenterology, Groot Ziekengasthuis, Den Bosch, the Netherlands</affiliation></author><author xml:id="author-0007"><persName><forename type="first">J</forename><surname>Dent</surname></persName><affiliation>Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia</affiliation></author><author xml:id="author-0008"><persName><forename type="first">P</forename><surname>Zeitoun</surname></persName><affiliation>Department of Gastroenterology, Hopital Robert Derbre, Reims, France</affiliation></author><author xml:id="author-0009"><persName><forename type="first">N</forename><surname>Havu</surname></persName><affiliation>AstraZeneca R&D, Södertalje, Sweden</affiliation></author><author xml:id="author-0010"><persName><forename type="first">M</forename><surname>Lamm</surname></persName><affiliation>AstraZeneca R&D, Mölndal, Sweden</affiliation></author><author xml:id="author-0011"><persName><forename type="first">A</forename><surname>Walan</surname></persName><affiliation>AstraZeneca R&D, Mölndal, Sweden</affiliation></author><idno type="istex">90ECB6E19A2425EA04D2907BFE3DB28A49D281AE</idno><idno type="ark">ark:/67375/NVC-98K7X1MZ-P</idno><idno type="DOI">10.1136/gut.53.1.12</idno><idno type="href">gutjnl-53-12.pdf</idno><idno type="PMID">14684569</idno><idno type="local">0530012</idno></analytic><monogr><title level="j">Gut</title><title level="j" type="abbrev">Gut</title><idno type="pISSN">0017-5749</idno><idno type="eISSN">1468-3288</idno><idno type="PublisherID-hwp">gutjnl</idno><idno type="PublisherID-nlm-ta">Gut</idno><imprint><publisher>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><date type="published" when="2004-01"></date><biblScope unit="volume">53</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="12">12</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2003-12-18</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background:Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective randomised study aimed to investigate whether H pylori eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastro-oesophageal reflux disease (GORD). Methods: A total of 231 H pylori positive GORD patients who had been treated for ⩾12 months with omeprazole maintenance therapy (OM) were randomised to either continuation of OM (OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and H pylori density. Results: Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, H pylori was eradicated in 90 (88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus (p<0.001, baseline v two years). Atrophic gastritis also improved in the corpus (p<0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased (p<0.01). H pylori eradication did not alter the dose of omeprazole required, or reflux symptoms. Conclusions: Most H pylori positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of H pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. H pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of H pylori in GORD patients receiving long term acid suppression.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>Helicobacter pylori</term></item><item><term>gastro-oesophageal reflux disease</term></item><item><term>gastritis</term></item><item><term>atrophy</term></item><item><term>gastric cancer</term></item><item><term>omeprazole</term></item><item><term>randomised controlled trial</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>GORD, gastro-oesophageal reflux disease</term></item><item><term>PPI, proton pump inhibitor</term></item><item><term>OM, omeprazole</term></item><item><term>OAC, omeprazole, amoxycillin, clarithromycin</term></item><item><term>OMC, omeprazole, metronidazole, clarithromycin</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Campylobacter, Salmonella, Shigella, Escherichia coli</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Helicobacter pylori</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Gastro-oesophageal reflux</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Stomach and duodenum</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Pancreatic cancer</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2003-12-18">Created</change><change when="2004-01">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/90ECB6E19A2425EA04D2907BFE3DB28A49D281AE/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="other"><front><journal-meta><journal-id journal-id-type="hwp">gutjnl</journal-id><journal-id journal-id-type="nlm-ta">Gut</journal-id><journal-title>Gut</journal-title><abbrev-journal-title abbrev-type="publisher">Gut</abbrev-journal-title><issn pub-type="ppub">0017-5749</issn><issn pub-type="epub">1468-3288</issn><publisher><publisher-name>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">0530012</article-id><article-id pub-id-type="other">gutjnl;53/1/12</article-id><article-id pub-id-type="doi">10.1136/gut.53.1.12</article-id><article-id pub-id-type="pmid">14684569</article-id><article-id pub-id-type="other">12</article-id><article-id pub-id-type="other">gut.53.1.12</article-id><article-categories><subj-group subj-group-type="heading"><subject>Oesophagus</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Campylobacter, Salmonella, Shigella, Escherichia coli</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Helicobacter pylori</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Gastro-oesophageal reflux</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Stomach and duodenum</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Pancreatic cancer</subject></subj-group></article-categories><title-group><article-title>Cure of <italic>Helicobacter pylori</italic> infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kuipers</surname><given-names>E J</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Nelis</surname><given-names>G F</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Klinkenberg-Knol</surname><given-names>E C</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Snel</surname><given-names>P</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Goldfain</surname><given-names>D</given-names></name><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kolkman</surname><given-names>J J</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Festen</surname><given-names>H P M</given-names></name><xref rid="AFF7">7</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Dent</surname><given-names>J</given-names></name><xref rid="AFF8">8</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Zeitoun</surname><given-names>P</given-names></name><xref rid="AFF9">9</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Havu</surname><given-names>N</given-names></name><xref rid="AFF10">10</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lamm</surname><given-names>M</given-names></name><xref rid="AFF11">11</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Walan</surname><given-names>A</given-names></name><xref rid="AFF11">11</xref></contrib><aff id="AFF1"><label>1</label>Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands</aff><aff id="AFF2"><label>2</label>Department of Gastroenterology, Sophia Hospital, Zwolle, the Netherlands</aff><aff id="AFF3"><label>3</label>Department of Gastroenterology, Free University Hospital, Amsterdam, the Netherlands</aff><aff id="AFF4"><label>4</label>Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands</aff><aff id="AFF5"><label>5</label>Department of Gastroenterology, Hopital Victor Jusselin, Dreux, France</aff><aff id="AFF6"><label>6</label>Department of Gastroenterology, Medical Spectrum Twente, Enschede, the Netherlands</aff><aff id="AFF7"><label>7</label>Department of Gastroenterology, Groot Ziekengasthuis, Den Bosch, the Netherlands</aff><aff id="AFF8"><label>8</label>Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia</aff><aff id="AFF9"><label>9</label>Department of Gastroenterology, Hopital Robert Derbre, Reims, France</aff><aff id="AFF10"><label>10</label>AstraZeneca R&D, Södertalje, Sweden</aff><aff id="AFF11"><label>11</label>AstraZeneca R&D, Mölndal, Sweden</aff></contrib-group><author-notes><corresp>Correspondence to:
Professor E J Kuipers
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands; <ext-link xlink:href="e.j.kuiperserasmusmc.nl" ext-link-type="email" xlink:type="simple">e.j.kuipers@erasmusmc.nl</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>1</month><year>2004</year></pub-date><pub-date pub-type="epub"><day>18</day><month>12</month><year>2003</year></pub-date><volume>53</volume><volume-id pub-id-type="other">53</volume-id><volume-id pub-id-type="other">53</volume-id><issue>1</issue><issue-id pub-id-type="other">gutjnl;53/1</issue-id><issue-id pub-id-type="other">1</issue-id><issue-id pub-id-type="other">53/1</issue-id><fpage>12</fpage><history><date date-type="accepted"><day>27</day><month>05</month><year>2003</year></date></history><permissions><copyright-statement>Copyright 2004 by Gut</copyright-statement><copyright-year>2004</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="gutjnl-53-12.pdf"></self-uri><abstract xml:lang="en"><p><bold>Background:</bold><italic>Helicobacter pylori</italic> gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of <italic>H pylori</italic> gastritis. This prospective randomised study aimed to investigate whether <italic>H pylori</italic> eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastro-oesophageal reflux disease (GORD).</p><p><bold>Methods:</bold> A total of 231 <italic>H pylori</italic> positive GORD patients who had been treated for ⩾12 months with omeprazole maintenance therapy (OM) were randomised to either continuation of OM (OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and <italic>H pylori</italic> density.</p><p><bold>Results:</bold> Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, <italic>H pylori</italic> was eradicated in 90 (88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus (p<0.001, baseline <italic>v</italic> two years). Atrophic gastritis also improved in the corpus (p<0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased (p<0.01). <italic>H pylori</italic> eradication did not alter the dose of omeprazole required, or reflux symptoms.</p><p><bold>Conclusions:</bold> Most <italic>H pylori</italic> positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of <italic>H pylori</italic> eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. <italic>H pylori</italic> eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of <italic>H pylori</italic> in GORD patients receiving long term acid suppression.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>Helicobacter pylori</kwd><kwd>gastro-oesophageal reflux disease</kwd><kwd>gastritis</kwd><kwd>atrophy</kwd><kwd>gastric cancer</kwd><kwd>omeprazole</kwd><kwd>randomised controlled trial</kwd></kwd-group><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>GORD, gastro-oesophageal reflux disease</kwd><kwd>PPI, proton pump inhibitor</kwd><kwd>OM, omeprazole</kwd><kwd>OAC, omeprazole, amoxycillin, clarithromycin</kwd><kwd>OMC, omeprazole, metronidazole, clarithromycin</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial</title></titleInfo><name type="personal"><namePart type="given">E J</namePart><namePart type="family">Kuipers</namePart><affiliation>Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G F</namePart><namePart type="family">Nelis</namePart><affiliation>Department of Gastroenterology, Sophia Hospital, Zwolle, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E C</namePart><namePart type="family">Klinkenberg-Knol</namePart><affiliation>Department of Gastroenterology, Free University Hospital, Amsterdam, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Snel</namePart><affiliation>Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D</namePart><namePart type="family">Goldfain</namePart><affiliation>Department of Gastroenterology, Hopital Victor Jusselin, Dreux, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J J</namePart><namePart type="family">Kolkman</namePart><affiliation>Department of Gastroenterology, Medical Spectrum Twente, Enschede, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H P M</namePart><namePart type="family">Festen</namePart><affiliation>Department of Gastroenterology, Groot Ziekengasthuis, Den Bosch, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J</namePart><namePart type="family">Dent</namePart><affiliation>Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Zeitoun</namePart><affiliation>Department of Gastroenterology, Hopital Robert Derbre, Reims, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N</namePart><namePart type="family">Havu</namePart><affiliation>AstraZeneca R&D, Södertalje, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M</namePart><namePart type="family">Lamm</namePart><affiliation>AstraZeneca R&D, Mölndal, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Walan</namePart><affiliation>AstraZeneca R&D, Mölndal, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="other" displayLabel="other" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-7474895G-0">other</genre><originInfo><publisher>BMJ Publishing Group Ltd and British Society of Gastroenterology</publisher><dateIssued encoding="w3cdtf">2004-01</dateIssued><dateCreated encoding="w3cdtf">2003-12-18</dateCreated><copyrightDate encoding="w3cdtf">2004</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Background:Helicobacter pylori gastritis may progress to glandular atrophy and intestinal metaplasia, conditions that predispose to gastric cancer. Profound suppression of gastric acid is associated with increased severity of H pylori gastritis. This prospective randomised study aimed to investigate whether H pylori eradication can influence gastritis and its sequelae during long term omeprazole therapy for gastro-oesophageal reflux disease (GORD). Methods: A total of 231 H pylori positive GORD patients who had been treated for ⩾12 months with omeprazole maintenance therapy (OM) were randomised to either continuation of OM (OM only; n = 120) or OM plus a one week course of omeprazole, amoxycillin, and clarithromycin (OM triple; n = 111). Endoscopy with standardised biopsy sampling as well as symptom evaluation were performed at baseline and after one and two years. Gastritis was assessed according to the Sydney classification system for activity, inflammation, atrophy, intestinal metaplasia, and H pylori density. Results: Corpus gastritis activity at entry was moderate or severe in 50% and 55% of the OM only and OM triple groups, respectively. In the OM triple group, H pylori was eradicated in 90 (88%) patients, and activity and inflammation decreased substantially in both the antrum and corpus (p<0.001, baseline v two years). Atrophic gastritis also improved in the corpus (p<0.001) but not in the antrum. In the 83 OM only patients with continuing infection, there was no change in antral and corpus gastritis activity or atrophy, but inflammation increased (p<0.01). H pylori eradication did not alter the dose of omeprazole required, or reflux symptoms. Conclusions: Most H pylori positive GORD patients have a corpus predominant pangastritis during omeprazole maintenance therapy. Eradication of H pylori eliminates gastric mucosal inflammation and induces regression of corpus glandular atrophy. H pylori eradication did not worsen reflux disease or lead to a need for increased omeprazole maintenance dose. We therefore recommend eradication of H pylori in GORD patients receiving long term acid suppression.</abstract><note type="author-notes">Correspondence to:
Professor E J Kuipers
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e.j.kuipers@erasmusmc.nl</note><subject lang="en"><genre>KWD</genre><topic>Helicobacter pylori</topic><topic>gastro-oesophageal reflux disease</topic><topic>gastritis</topic><topic>atrophy</topic><topic>gastric cancer</topic><topic>omeprazole</topic><topic>randomised controlled trial</topic></subject><subject lang="en"><genre>ABR</genre><topic>GORD, gastro-oesophageal reflux disease</topic><topic>PPI, proton pump inhibitor</topic><topic>OM, omeprazole</topic><topic>OAC, omeprazole, amoxycillin, clarithromycin</topic><topic>OMC, omeprazole, metronidazole, clarithromycin</topic></subject><relatedItem type="host"><titleInfo><title>Gut</title></titleInfo><titleInfo type="abbreviated"><title>Gut</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>Campylobacter, Salmonella, Shigella, Escherichia coli</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Helicobacter pylori</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Gastro-oesophageal reflux</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Stomach and duodenum</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Pancreatic cancer</topic></subject><identifier type="ISSN">0017-5749</identifier><identifier type="eISSN">1468-3288</identifier><identifier type="PublisherID-hwp">gutjnl</identifier><identifier type="PublisherID-nlm-ta">Gut</identifier><part><date>2004</date><detail type="volume"><caption>vol.</caption><number>53</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>12</start></extent></part></relatedItem><identifier type="istex">90ECB6E19A2425EA04D2907BFE3DB28A49D281AE</identifier><identifier type="ark">ark:/67375/NVC-98K7X1MZ-P</identifier><identifier type="DOI">10.1136/gut.53.1.12</identifier><identifier type="href">gutjnl-53-12.pdf</identifier><identifier type="PMID">14684569</identifier><identifier type="local">0530012</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright 2004 by Gut</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</recordContentSource><recordOrigin>Copyright 2004 by Gut</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/90ECB6E19A2425EA04D2907BFE3DB28A49D281AE/metadata/json</uri></json:item></metadata><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/document/90ECB6E19A2425EA04D2907BFE3DB28A49D281AE/annexes/jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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