The natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: the Sørreisa gastrointestinal disorder study

Abstract

The natural course of Helicobacter pylori (H. pylori) is poorly understood, as most research in the field has been on patient populations. We studied the natural course of H. pylori and its associations to morphological changes of the gastric mucosa, peptic ulcer, and reflux oesophagitis in a prospective cohort study of subjects with and without dyspepsia. A total of 361 adults (201 men/160 women, mean age 41/42 years) in Sørreisa municipality, Norway who in 1987 were subjected to upper endoscopy and assessed for gastrointestinal symptoms and H. pylori status were followed up in 2004. H. pylori was strongly associated with neutrophilic (odds ratio [OR] 23.79; 95% confidence interval [CI] 11.64:48.61) and mononuclear infiltration (OR 9.43; CI 5.12:17.36), moderately with atrophy of the antrum (OR 1.98; CI 1.17:3.34), but not with atrophy of the gastric body or intestinal metaplasia. Elimination of H. pylori was associated with regression of gastric inflammation and atrophy, whereas intestinal metaplasia progressed. H. pylori was positively associated with peptic ulcer (OR 2.69; CI 1.2:6.02) but not significantly negatively associated with oesophagitis (OR 0.62; CI 0.35:1.09). This is the first prospective study including endoscopic findings of subjects without dyspepsia, to show that the impact of H. pylori on gastric atrophy is only modest, and that eliminating H. pylori does not cause regression of intestinal metaplasia. However, inflammation of the gastric mucosa regresses after H. pylori elimination. H. pylori is only a moderate risk factor for peptic ulcer, and other explanatory factors deserve more attention.

Impact of Helicobacter pylori Infection and Microscopic Duodenal Histopathological Changes on Clinical Symptoms of Patients with Functional Dyspepsia

“…In the presenting study, the prevalence of H. pylori infection in FD patients, in accordance with previous studies in developing countries [7,9], was also found to be relatively high (67.3%), but most of the subjects in our study suffering from FD were females (70.1%) while previous studies reported no significant difference between males and females in this regard [12,31,32].…”

Towards a healthy stomach? Helicobacter pylori prevalence has dramatically decreased over 23 years in adults in a Swedish community

“…11 Kosunen et al showed that the age-adjusted seroprevalence rate declined from 56% to 31% in Finland between 1973 and 1994 (p ¼ 0.001). 10 12 In contrast, one Danish population-based cohort study reported a stable prevalence of seropositive of H. pylori infection: 24.7% in 1983 and 24.5% in 1994. 31 Two earlier Swedish point prevalence studies from the general population are also of interest.…”

The Shanghai Changfeng Study: a community-based prospective cohort study of chronic diseases among middle-aged and elderly: objectives and design

“…All clinical information will be obtained by interview and clinical examination. Recent EJE references are [101][102][103][104][105].…”