Improvement of gastric atrophy after cure of Helicobacter pylori. What we know, what we don't know, and why care?

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Helicobacter pylori eradication and associated changes in the gastric mucosa

Persistent Helicobacter pylori infection contributes towards the development of chronic gastritis. To clarify the changes in chronic gastritis as a precursor of gastric cancer secondary to H. pylori eradication is an important issue, as it has significant implications for reducing the risk of gastric cancer. Studies published to date, however, are far from consistent with regard to the morphologic changes reported following H. pylori eradication. Of these, some papers reported improvement in gastric atrophy or intestinal metaplasia, versus others reporting no improvement, with the majority of papers published after 2000 reporting improvement in these end points. The inconsistent results concerning the impact of H. pylori eradication on gastric atrophy could be due to the inconsistency of the diagnostic criteria employed for evaluation of the morphology, confounded by the difficulties involved in evaluating atrophic changes in the gastric mucosa. While adherence to the Updated Sydney System available for evaluation of gastritis is primarily required worldwide to ensure consistency in evaluating gastritis, long-term research into the morphologic changes associated with H. pylori eradication is also required to explore strategies for the prevention of gastric cancer with H. pylori eradication.

Effects of H. pylori eradication with liaowei decoction on pathology of H. pylori-associated chronic gastritis in rats

AIM: To evaluate the effects of H. pylori eradication with liaowei decoction on pathologic changes and COX-2 expression of H. pylori-associated chronic gastritis in rats.

METHODS: A total of 80 grade-II male Wister rats weighing 80-100 g were given H. pylori and MNNG to prepare H. pylori-associated chronic gastritis model with 4 mice dead. Among them, 54 rats with H. pylori serum antibody positive were randomly divided into 4 groups: H. pylori eradication with liaowei decoction (14 rats); H. pylori eradication with Maizilin (positive control, 14 rats); spontaneous recovery (negative control, 13 rats); and simple H. pylori eradication therapy (13 rats). After treatment, both Gram staining of gastric antrum mucosal smear and rapid urease testing were made to detect the H. pylori colonization of the gastric mucosa and to assess the histological indexes of gastric antrum mucosa. Immunohistochemical staining was also performed to detect COX-2 expression.

RESULTS: The colonization of gastric mucosa by H. pylori was found in rats from spontaneous recovery group, as an indication of long-term continuous H. pylori infection, while no colonization was found in rats from other groups. Pathological changes of gastric antrum mucosa included moderate gastric mucosal atrophy in rats from spontaneous recovery group (pathologic integration 2.0±0.20 points), associatded with moderate acute or chronic gastric mucosal inflammation (pathologic integrations were 2.0±0.20 points and 1.90±0.39 points, respectively). In comparison with spontaneous recovery group, treatment effectiveness in the group of H. pylori eradication with liaowei decoction was remarkably different (P < 0.05). The gastric mucosal atrophy in the combination group (pathologic integration 1.25±0.44 points) was less severe, while acute gastric mucosal inflammation (pathologic integration 0.3±0.47 points) was extincted, and chronic inflammation (pathologic integration 1.05±0.22 points) was less severe; For the group of H. pylori eradication and "Maizilin", pathologic integration of gastric mucosal atrophy was 2.0±0.43 points. In comparison with spontaneous recovery group, there was no remarkable difference, however, acute inflammation was extincted and chronic inflammation was the same as before. Gastric mucosal atrophy and chronic inflammation were more severe in simple H. pylori eradication group than those in spontaneous recovery group, while active inflammatory changes extincted. COX-2 expression of gastric antrum mucosa in the group of simple H. pylori eradication, group of H. pylori eradication with liaowei decoction, group of H. pylori eradication and Maizilin as well as spontaneous recovery group were 14%±3.7%, 10%±3.8%, 13%±4.0% and 19%±10.2%, respectively. In comparison with spontaneous recovery group, COX-2 expression of the treatment groups were greatly decreased as an indication of remarkable difference (P < 0.05).

CONCLUSION: COX-2 expression and acute inflammation can be greatly decreased by applying H. pylori eradication therapy in the treatment of H. pylori-associated chronic gastritis, but the therapy cannot do much to chronic pathologic changes, especially to atrophic changes. Application of the combined therapy of H. pylori eradication with "liaowei decoction" for 12 weeks will have better treatment effectiveness on chronic pathologic changes, especially atrophic changes.