The relationship between sydney classification and first line treatment in helicobacter pylori gastritis

Introduction: Helicobacter pylori (H. pylori), with a prevalence of approximately 85% in our country, is responsible for a wide spectrum of diseases ranging from peptic ulcer to gastric cancer. Although different treatment regimens are available for H. pylori eradication, standard triple therapy is currently being used as first-line eradication in many areas due to ease of use and accessibility. Intestinal metaplasia (IM) caused by H. pylori, is a precancerous lesion that requires eradication therapy. Herein, we aimed to investigate the effect of IM on standard triple therapy success in H. pylori positive patients. Materials and Method: The patients who referred to Düzce University Medical Faculty Gastroenterology Clinic and Avrasya Hospital General Surgery Clinic between January 2014 and December 2016, diagnosed with H. pylori positive gastritis after analysis of the biopsy specimen obtained during esophagogastroduodenoscopy and underwent first-line eradication therapy, were evaluated retrospectively. Biopsy specimens of patients were evaluated for the presence of chronic inflammation, glandular atrophy, neutrophil activation and IM according to the updated Sydney system. All patients diagnosed with H. pylori started treatment with pantoprazole 1g bid, amoxicillin 1g bid and clarithromycin 500 mg bid for 14 days. Patients were evaluated for H. pylori eradication success by gastric biopsy or fecal H. pylori antigen test 15 days after the treatment ends. Results: The mean age of the 181 patients included in the study was 55.5 ± 7.8 and 52% were female. The success rate of H. pylori eradication was found to be low in severe chronic inflammation (p=0.001). While the success rate was found to be high among patients with no neutrophil activity (p=0.009), there was no correlation between glandular atrophy severity and IM severity and H. pylori eradication success rate (p=0.390 and p=0.812). As the intensity of IM increased, H. pylori intensity was found to be decreased (p=0.019). Discussion: We found that glandular atrophy and IM do not have a significant effect on H. pylori eradication success. As the intensity of IM increases, H. pylori cannot provide a suitable living environment for itself secondary to altered cell structure, leading to a low H. pylori density in areas with metaplasia. The significant decrease in H. pylori intensity as the severity of IM increases is considered the reason for the irresponsiveness of H. pylori eradication treatment in severe IM.