Does Helicobacter Pylori eradication modify intestinal metaplasia evolution in the stomach?

Carditis has been associated with H.pylori infection and pan-gastritis.The role of GERD in the aetiology of cardia inflammation is debated.Gastric adenocarcinoma is increasing in prevalence, and the role of cardia intestinal metaplasia is unknown.Aim:To determine the prevalence of carditis and cardia I.M. and their disease associations.Methods:Consecutive patients undergoing routine endoscopy in a single university center were recruited.The endoscopic diagnosis was recorded.Biopsies were obtained in all cases as follows.Two each from the antrum, corpus, incisura, cardia and oesophagus (2cm above the squamocolumnar junction) for histology (Sydney classification) and two further antral biopsies for a rapid urease test and culture.Patients were considered H.p positive if any two tests were positive or if culture was positive.Exclusion criteria included, recent consumption of antibiotics or use of antacids or NSAID's, previous gastric or oesophageal surgery.Results:One hundred and fifty four patients were recruited, 61 (40%) were H.p positive and 51 (33%) had endoscopic oesophagitis.The prevalence of carditis and cardia I.M. was 91 (59%) and 15 (lO%)respectively.H.p infection was significantly associated with carditis p<0.OO2.GERO alone accounted for 20% of cases with carditis.Of 15 cases of I.M. 3(20%)had H.p infection and 5 (33%) Barrett's disease.Seven cases of cardia 1M had GERO without either endoscoscopic or histological evidence of Barrett's disease and were H.p negative.In all seven the 1M was of immature subtype.Conclusion: Carditis occurs with H.p infection and GERO.I.M of the cardia is uncommon, 10% of cases.In the presence of multi focal atrophic gastritis and H.p infection LM may be found in the cardia in conjunction with other distal sites.Immature type cardia 1M is associated with Barrett's and GERD.Immature I.M in patients with GERD without Barrett's suggests that GERD is primarily responsible for cardia damage in these patients. Carditis and disease associations H.p n=61 GERD n=51Barretts n••24 Total n=91 4054