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Objectives The aim of this study was to assess the consequences of prolongedHelicobacter pylorieradication on gastric antral mucosa in duodenal ulcer patients. Patients and methods Forty-three duodenal ulcer patients with confirmedH. pylorieradication after one year of follow-up were included in this retrospective study. BeforeH. pylorieradication and during the follow-up, four antral prepyloric biopsy samples were taken for histopathological examination and culture. Patients and methods Histopathological lesions were graded semi-quantitatively according to the updated Sydney System for activity, chronic inflammation, glandular atrophy and intestinal metaplasia (IM), as well as presence of lymphoid follicles. Results After a mean follow-up of 43 ± 23 months,H. pylorieradication statistically improved all gastritis scores, including the atrophy score and the lymphoid follicle score but excluding the IM score.H. pylorieradication resulted in normalization of gastric mucosa in 51.2% of patients and a significantly lower proportion of patients with non-atrophic gastritis and atrophic gastritis without IM. Atrophy totally disappeared in 16/29 patients (55.2%) in whom IM was absent. No predictive factor for regression of atrophy or normalization of gastric mucosa was identified. Conclusion In duodenal ulcer patients, prolonged absence (more than one year) ofH. pylorican lead to normalization of the antral mucosa and the disappearance of mucosaassociated lymphoid tissue, as well as the regression of antral atrophy. Long-term studies involving selected patients with atrophy and IM which persist afterH. pylorieradication are needed to determine the potential benefits of treatingH. pylorigastritis with regard to gastric cancer prevention.Eur J Gastroenterol Hepatol12:719-725

Objectives: The eradication of Helicobacter pylori is recommended in duodenal ulcer disease. The aim of this randomized open trial was to evaluate and compare H. pylori eradication and safety after a dual therapy consisting of lansoprazole (30 mg b.i.d.) and amoxicillin (1 g b.i.d.) versus a triple therapy consisting of lansoprazole (30 mg b.i.d.), amoxicillin (1 g b.i.d.), and clarithromycin (500 mg b.i.d.) administered from day 1 to day 14. Methods : All patients with an ulcer received lansoprazole (30 mg) from day 15 to day 28. H. pylori status was determined from antral biopsies using histology, culture, and polymerase chain reaction (PCR) upon inclusion and 1-3 months after the end of the treatment. Results: Of the 50 patients included in the study, five did not adhere to the protocol. H. pylon eradication was obtained in 37.5% of the patients receiving lansoprazole-amoxicillin (n = 9/24) and in 95.2% of the patients receiving lansoprazole-amoxicillin.clarithromycin (n = 20/21, p < 0.0002). Minor side effects appeared in 8.3% of the cases during dual therapy (n = 2/24) and in 52% during triple therapy (n = 13/22, p < 0.001). These side effects consisted mainly of diarrhea and a metallic taste. Conclusion: Concommitant administration of double doses of lansoprazole with amoxicillin and clarithromycin is very efficacious against H. pylori infection compared with dual therapy.