Turkish Journal of Gastroenterology, vol.11, no.1, pp.20-24, 2000 (SCI-Expanded)
Helicobacter pylori (H. pylori) colonises only gastric type epithelium. In routine practice, H. pylori status is assessed on antral biopsy specimens alone. More recent reports suggest that eradication therapy partly suppresses, but does not eradicate H. pylori completely. This prospective study aimed to examine the effect of triple eradication therapy on the distribution of H. pylori and whether antral biopsy is sufficient for the evaluation of persistence of H. pylori within the stomach. Our study consisted of 102 patients with H. pylori infection, of whom 37 had peptic ulcer and 65 chronic antral gastritis H. pylori positivity was determined by both rapid urease test and histological examination. Subjects underwent an upper gastrointestinal endoscopy and biopsy specimens were taken from the gastric antrum, body, and fundus. They were then prescribed lansoprazole (30 mg bid), clarithromycin (500 mg bid), and amoxycillin (1 g bid) for a week. At the 8th week a second endoscopy was performed and further biopsy specimens were obtained from the same sites as at initial endoscopy. H. pylori was seen in 100 of 102 antral, 82 of 102 corpus, and 59 of 102 fundic biopsy specimens prior to eradication therapy. Two patients had no antral H. pylori. One of these patients had H. pylori in both the fundus and corpus. The remaining one patient had only fundic H. pylori infection. At the second endoscopy, H. pylori was found in the gastric fundus in 11 of 102, subjects, in the corpus in 10 of 102, and in the antrum in 10 of 102; the differences between fundus, corpus and antrum were not statistically significant. Persistent antral infection in eight patients may have resulted from generalised treatment failure as all had H. pylori throughout the stomach. After treatment, H. pylori was present in the corpus and fundus without antral infection in two subjects (1.96%) and in only fundus in one subject (0.98%). This study reveals that a one week lansoprazole clarithromycin and amoxycillin treatment is effective at clearing H. pylori from all over the stomach. Resistance to treatment documented by presence of H. pylori in both corpus and antrum of 2.94% of patients suggests that antral biopsy alone may be sufficient for confirmation of complete eradication.