Long‐Term Effect of Helicobacter pylori Eradication on Gastric Atrophy and Intestinal Metaplasia After Endoscopic Resection of Gastric Neoplasm: A Follow‐Up of a Randomized Controlled Trial

Background Our previous randomized controlled trial reported that Helicobacter pylori eradication reduced the risk of metachronous gastric cancer over a median follow‐up of 5.9 years in patients with early gastric cancer (EGC) and improved corpus gastric atrophy (GA) at the specific 3 year follow‐up time. This study aimed to evaluate the long‐term effects of H. pylori eradication on GA and intestinal metaplasia (IM) at trial closeout. Methods Among 470 patients randomized between 2003 and 2013, 327 who were assessed for GA and IM at both baseline and 3‐year follow‐up time were included in the study. At trial closeout, H. pylori status, GA, and IM were assessed. Main outcomes were improvement in GA and IM at the corpus lesser curvature (LC) according to the H. pylori status at the closeout time. The secondary outcomes included the Operative Link for Gastritis Assessment (OLGA) and Operative Link for Gastric Intestinal Metaplasia assessment (OLGIM) stage improvements. Results At a median follow‐up of 5.9 years (interquartile range: 4.0–8.2 years), an improvement in GA grades at the corpus LC was observed in 88 of the 150 patients (58.7%) in the H. pylori ‐eradicated group and 31 of the 158 patients (19.6%) in the H. pylori ‐persistent group (odds ratio [ OR ] in the H. pylori ‐eradicated group, 5.81; 95% confidence interval [ CI ], 3.49–9.68). IM grades showed greater improvement in the H. pylori ‐eradicated group (42.4% [67/158 patients]) compared with the H. pylori ‐persistent group (18.6% [31/167 patients]); OR in the eradicated group (3.23; 95% CI , 1.96–5.33). Similarly, the H. pylori ‐eradicated group exhibited significantly higher rates of improvement in both OLGA ( OR 6.48; 95% CI , 3.85–10.91) and OLGIM stages ( OR 2.31; 95% CI , 1.42–3.77). Conclusions In patients with EGC who have far advanced histologic changes in the background mucosa, H. pylori eradication was associated with a significant improvement in GA and IM.