Helicobacter pylori eradication combined with folic acid in the treatment of chronic atrophic gastritis: a long-term follow-up study

Objective To investigate the clinical and pathological outcome of gastric mucosa lesions in chronic atrophic gastritis treated with Helicobacter pylori (H.pylori) eradication combined with folic acid (three months treatments). Methods From December 2009 to December 2010, outpatients with chronic atrophic gastritis were selected and divided into H.pylori positive group and H.pylori negative group. The patients of H.pylori positive group were treated with standard triple H.pylori eradication therapy and then followed with folic acid; the patients of H.pylori negative group were only treated with folic acid. The treatment course of both groups was three months. H.pylori test and gastroscopy were carried out at 1st, 3rd and 5th year after treatment. According to the follow-up results, the patients were divided into H.pylori negative group, H.pylori successful eradication group and H.pylori reinfection group. Student′s t tests and Logistic regression were performed for statistical analysis. Results A total of 160 patients with chronic atrophic gastritis were included. There were 90 cases in H.pylori positive group and 70 cases in H.pylori negative group. There were 139 cases included after follow-up. There were 47 cases in H.pylori negative group, 63 cases in H.pylori successful eradication group, and 29 cases in H.pylori reinfection group. The gastric mucosal gastritis scores of H.pylori negative group significantly decreased at 1st, 3rd and 5th year after treatment (1.40±1.25, 1.54±0.61, and 1.63±0.94, respectively) compared with that before treatment (2.63±1.21), and the differences were statistically significant (t=4.073, 3.669 and 4.433, all P 0.05). The failure of H.pylori eradication(odds ratio (OR)=5.600, P=0.002) and H.pylori reinfection(OR=4.750, P=0.001)were both progression risk factors of chronic atrophic gastritis. Gender (female, OR=0.371), smoking (OR=3.357) and drinking (OR=3.368) were all risk factors of H.pylori reinfection (all P<0.05). Conclusion H.pylori eradiation combined with folic acid treatment can relieve mucosa inflammation in patients with chronic atrophic gastritis, improve atrophy and intestinal metaplasia. Key words: Chronic atrophic gastritis; Helicobacter pylori eradication; Folic acid; Follow-up studies