natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: the Sørreisa gastrointestinal disorder study

• Published in: European journal of epidemiology Vol. 24; no. 10; pp. 649 - 658
• Main Authors: Asfeldt, Anne Mette, Steigen, Sonja Eriksson, Løchen, Maja-Lisa, Straume, Bjørn, Johnsen, Roar, Bernersen, Bjørn, Florholmen, Jon, Paulssen, Eyvind J
• Format: Journal Article
• Language: English
• Published: Dordrecht Dordrecht : Springer Netherlands 2009; Springer; Springer Netherlands; Springer Nature B.V
• Subjects: Adult; Aged; Bacteria; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Biopsy; Cardiology; Cohort Studies; Dyspepsia; Dyspepsia - epidemiology; Dyspepsia - etiology; Dyspepsia - pathology; Endoscopy; Endoscopy, Gastrointestinal; Epidemiology; Esophagitis - epidemiology; Female; Gastric Mucosa - pathology; Gastritis - epidemiology; Gastritis - etiology; Gastritis - pathology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal reflux; Health risk assessment; Helicobacter Infections - complications; Helicobacter Infections - epidemiology; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - isolation & purification; Human bacterial diseases; Humans; Infections; Infectious Diseases; Inflammation; Logistic Models; Logistic regression; Male; Medical sciences; Medicine; Medicine & Public Health; Metaplasia; Middle Aged; Miscellaneous; Norway - epidemiology; Oncology; Other diseases. Semiology; Peptic ulcer; Peptic Ulcer - epidemiology; Population Groups; Predisposing factors; Prospective Studies; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Stomach; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Ulcers; Norway; Europe; Peptic ulcer disease; Risk assessment; Cohort studies; Gastritis; Disease; Spirillaceae; Risk; Gastrointestinal; Epidemiology; Gastroduodenal; Helicobacter pylori; Cohort study; Bacteria; Intestinal disease; Population; Endoscopy; Public health; Gastric disease; Human; Spirillales; Peptic ulcer; Infection; Risk factor; Bacteriosis; Digestive diseases
• ISSN: 0393-2990; 1573-7284
• DOI: 10.1007/s10654-009-9371-6

The natural course of Helicobacter pylori (H. pylori) is poorly understood, as most research in the field has been on patient populations. We studied the natural course of H. pylori and its associations to morphological changes of the gastric mucosa, peptic ulcer, and reflux oesophagitis in a prospective cohort study of subjects with and without dyspepsia. A total of 361 adults (201 men/160 women, mean age 41/42 years) in Sørreisa municipality, Norway who in 1987 were subjected to upper endoscopy and assessed for gastrointestinal symptoms and H. pylori status were followed up in 2004. H. pylori was strongly associated with neutrophilic (odds ratio [OR] 23.79; 95% confidence interval [CI] 11.64:48.61) and mononuclear infiltration (OR 9.43; CI 5.12:17.36), moderately with atrophy of the antrum (OR 1.98; CI 1.17:3.34), but not with atrophy of the gastric body or intestinal metaplasia. Elimination of H. pylori was associated with regression of gastric inflammation and atrophy, whereas intestinal metaplasia progressed. H. pylori was positively associated with peptic ulcer (OR 2.69; CI 1.2:6.02) but not significantly negatively associated with oesophagitis (OR 0.62; CI 0.35:1.09). This is the first prospective study including endoscopic findings of subjects without dyspepsia, to show that the impact of H. pylori on gastric atrophy is only modest, and that eliminating H. pylori does not cause regression of intestinal metaplasia. However, inflammation of the gastric mucosa regresses after H. pylori elimination. H. pylori is only a moderate risk factor for peptic ulcer, and other explanatory factors deserve more attention.