Rebamipide improves chronic inflammation in the lesser curvature of the corpus after Helicobacter pylori eradication: a multicenter study.

Background and Aim. Although many epidemiologic studies have shown that Helicobacter pylori eradication has prophylactic effects on gastric cancer, it does not completely eliminate the risk of gastric cancer. We aimed to investigate the changes in histological gastritis in patients receiving rebamipide treatment after H. pylori eradication. Methods. 206 patients who had undergone H. pylori eradication were evaluated. Of these, 169 patients who achieved successful eradication were randomly allocated to 2 groups: the rebamipide group (n = 82) and the untreated group (n = 87). The primary endpoints were histopathological findings according to the updated Sydney system at the start of the study and after 1 year. Results. Final assessment for histological gastritis was possible in 50 cases from the rebamipide group and 53 cases from the untreated group. The activity and atrophy improved in both the rebamipide and untreated groups, and no significant intergroup differences were observed. Chronic inflammation affecting the lesser curvature of the corpus was significantly improved in the rebamipide group compared to in the untreated group (1.12 ± 0.08 versus 1.35 ± 0.08; P = 0.043). Conclusions. Rebamipide treatment after H. pylori eradication alleviated chronic inflammation in the lesser curvature of the corpus compared to that in the untreated group. This trial is registered with UMIN000002369.

Relation between bile acid reflux into the stomach and the risk of atrophic gastritis and intestinal metaplasia: a multicenter study of 2283 cases.

BACKGROUND: The relationship between bile acid reflux into the stomach and the risk of atrophic gastritis and intestinal metaplasia is still not well understood. Towards obtaining a better understanding, concentrations of bile acids were measured. PATIENTS AND METHODS: This study was carried out with the participation of 14 facilities in Japan, and 2283 samples were collected. The subjects with bile acid concentrations equal to or higher than the limit of detection were divided into four groups of equal size (group A: 0-25%, group B: 26-50%, group C: 51-75%, and group D: 76-100%). Thus, including the control group, there were five groups in total. The odds that the control group would develop atrophic gastritis and intestinal metaplasia was set as 1,and the odds ratios (OR) in groups A, B, C and D were calculated based on the odds in the control group. RESULTS: Regarding the development of atrophic gastritis, no increased risk was observed in either the Helicobacter pylori (H. pylori)-positive or -negative cases. The OR for the development of intestinal metaplasia were significantly higher, for both cases with and without H. pylori infection, in group D. CONCLUSION: High concentrations of bile acid seem to be associated with an elevated risk of intestinal metaplasia.

Clinical characteristics of Japanese dyspeptic patients: is the Rome III classification applicable?

OBJECTIVE: While the Rome III classification seems logical, some aspects need further evaluation. The aim of this study was to evaluate the clinical characteristics of Japanese dyspeptic patients and to determine whether this classification could be applied to them. MATERIAL AND METHODS: A total of 364 consecutive patients with a mean age of 54.5 years who had chronic symptoms occurring at least several times per week that could be attributed to the upper gastrointestinal tract were recruited. All of them underwent blood tests, ultrasonography, and endoscopy, which revealed no organic, systemic, or metabolic diseases. They also answered a questionnaire about their symptoms. RESULTS: The subjects were divided into a postprandial distress symptom (PDS) group, epigastric pain symptom (EPS) group, and chronic idiopathic nausea symptom group. There was considerable overlap among these groups (109/198, 55.1%), and patients with non-erosive reflux disease accounted for 52.0% (103/198) of all subjects. The Rome III classification could not be applied to 62.7% of the PDS group and 61.3% of the EPS group because the onset of symptoms occurred less than 6 months before diagnosis (4.6 +/- 0.4 months for PDS and 4.6 +/- 0.5 months for EPS). CONCLUSIONS: The current Rome III criteria for functional dyspepsia dose not adequately identify a large proportion of Japanese dyspeptic patients, primarily due to earlier presentation for medical evaluation. Therefore, the 6-month period after onset of dyspeptic symptoms should be shortened at least in the Japanese population experiencing dyspeptic symptoms.