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Acquisition of infection in adults is rare. It is unlikely, therefore, that reinfection will occur after successful eradication.

Helicobacter pylori causes chronic active gastritis and is thought to be associated with the development of gastric atrophy, intestinal metaplasia and carcinoma. As the effect of H. pylori eradication on this process is poorly understood, we sought to determine the long-term effects of H. pylori eradication on gastric histology. Fifty-four patients with duodenal ulceration associated with H. pylori infection received H. pylori eradication therapy in 1985/86 and either remained infected (n = 22) or had the infection eradicated (n = 32); patients were followed up by endoscopy with gastric antral biopsy for 7.1 years (mean). Histopathological analysis of gastric antral mucosa from patients rendered H. pylori-negative revealed a marked decrease in both inflammatory cells within the lamina propria and intraepithelial neutrophils and an increase in epithelial mucinogenesis. Gland atrophy remained unchanged in both H. pylori-positive and -negative patients. When examined for the presence and severity of intestinal metaplasia, there was neither a difference between the two patient groups nor a change with time. These data demonstrate that significant long-term improvements in gastric histology accompany H. pylori eradication when compared with histology in patients with persistent infection. Whether this confers a protective effect by reducing the risk of gastric carcinoma remains unknown.

SUMMARY Multiple specimens taken at oesophageal suction biopsy were obtained from 56 patients, of whom 44 had symptoms of gastro-oesophageal reflux and 24 had endoscopic evidence of erosive oesophagitis. Biopsies were examined independently by two histopathologists for the following criteria for reflux: epithelial hyperplasia, vascular dilatation and congestion, neutrophil infiltration, and eosinophil infiltration. The incidence of these criteria in patients with and without endoscopic evidence of oesophagitis or symptoms of reflux was investigated. It was concluded that vascular dilatation and epithelial hyperplasia, defined as basal zone thickness > 15% and papillary elongation >66%, can be detected most reliably, but their diagnostic accuracy is limited unless multiple biopsies are examined.

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