Resolution of Gastritis Induced by <i>Helicobacter pylori</i> 4–5 Weeks after Successful Eradication of Infection Using a Triple Therapy Regimen of Pantoprazole, Amoxycillin and Clarithromycin for One Week

Abstract

This open-label study was designed to determine the extent of histological resolution of gastritis induced by Helicobacter pylori infection 4–5 weeks after successful eradication of the infection. Eradication was achieved using a triple therapy regimen consisting of a twice daily dose of pantoprazole 40 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg taken for 1 week only. No other medications were given thereafter. Four biopsies were processed for histological examination of each patient, two from the antral and two from the corporeal mucosa, first at the start of the study and then again 4 weeks after cessation of the medication trial. Scoring for H. pylori colonization and the severity of gastritis was determined for each patient according to the Sydney system. 53 of 57 patients in this study had their H. pylori infection successfully eradicated by the regimen mentioned and could be histologically evaluated. According to the severity of gastritis in the antral mucosa, patients were studied in 3 groups: mild, moderate and severe gastritis. 17 of 19 cases with mild gastritis showed complete resolution of the inflammation, with residual inflammatory changes persisting in 2 cases only. 22 of the 26 cases with moderate gastritis showed almost complete recovery except for minor residual inflammatory changes as judged by irregularity of intracytoplasmic mucine storage. Persistent residual inflammatory changes in the lamina propria were detected in 4 cases. Of the 8 cases with severe gastritis 5 showed subsidence of the inflammatory changes, but the mucosa in these cases revealed some scarring, distortion of the glandular epithelium and atrophy. In 3 cases residual inflammation persisted. Conclusion: One-week therapy with a twice daily dose of pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1,000 mg, used to eradicate H. pylori causing active inflammation of the gastric mucosa, has led to subsidence of the acute inflammatory changes in all the cases with residual inflammation persisting in 17%. Severe gastritis may cause irreparable damage to the gastric mucosa. The density of H. pylori colonization does not appear to be related to the severity of gastritis, nor to the successful eradication achieved.

Impact of Helicobacter pylori resistance to clarithromycin on the efficacy of the omeprazole–amoxicillin–clarithromycin therapy

“…The eradication rate was not statistically linked with bacterial density nor with gastritis activity. Our findings are in keeping with those of Abdul Aal et al ., who did not find a link between density estimated by histology and eradication rate 28 . In another work, H. pylori density has been found to be a predicting factor for eradication, but density was indirectly assessed by the urea breath test, stating that urease activity was related to density 29 .…”

Alteration of histological gastritis after cure of Helicobacter pylori infection

“…A total of 51 articles were selected according to the exclusion criteria 5 ,. 8–57 Included amongst the 40 articles that were available for the analysis of the change in activity, 5 , 8–46 there were 38 for inflammation, 5, 8–15, 17–21, 23–26, 28, 30, 31, 34–44, 46–51 25 for atrophy 5, 8–15, 17, 18, 21, 23, 25–28, 31, 36, 39, 44, 47, 49, 52, 53 and 28 for intestinal metaplasia 5, 8–15, 17, 21, 23, 25–29, 31, 36, 42, 44, 49, 52–57 (Table 1).…”

“…In all 40 reports that investigated the change in activity, the degree of activity improved greatly; some reports were included in which the complete disappearance of polymorphonuclear neutrophils was observed even without statistical analysis for activity. Twenty‐three reports described an early change in activity within 1 month after eradication therapy, and all 23 reported great improvement of activity 9, 14, 16, 17, 19, 22–24, 26, 27, 30, 33–38, 40, 42–46 …”

Treatment of Helicobacter pylori in the Arab world: a systematic review and network meta-analysis

“…Our sample consisted of a total of 7,829 patients, including both genders aged between 2 and 75 years. Studies from Egypt (n=18) [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] , Saudi Arabia (n=8) [46][47][48][49][50][51][52][53] , Lebanon (n=6) [54][55][56][57][58][59] , UAE (n=5) [60][61][62][63][64] , Iraq (n=3) [65][66][67] , Qatar (n=3) [68][69][70] , Algeria (n=2) 71,72 , Palestine (n=1) 73 , Morocco (n=1) 74 , Syria (n=1) 75 , Yemen (n=1) 76 Tunisia (n=1) 77 , Jordon (n=1) 54 , Sudan (n=1) …”