The Impact of Helicobacter pylori Eradication on the Outcomes of Gastric Mucosal Lesions

Background The eradication of Helicobacter pylori ( H. pylori ) has been shown to reduce the risk of progression of precancerous lesions to gastric cancer. However, whether H. pylori eradication can improve or even reverse atrophy and intestinal metaplasia (IM) remains a subject of debate. The objective of this study was to observe long-term histological changes in the gastric mucosa following H. pylori eradication and to monitor the occurrence of gastric cancer. Methods This retrospective analysis was conducted in patients with infection that was confirmed by endoscopy and pathology between January 2010 and December 2022. This study further examined changes in endoscopic and pathological findings at different time points (3, 5, 8, and 10 years and beyond) following H. pylori eradication. Comparisons were made between patients who achieved H. pylori eradication and those who did not, with a focus on differences in gastric mucosal inflammation, atrophy, and IM scores, as well as changes in the Operative Link for Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia (OLGIM) staging system. Additionally, the incidence of gastric cancer was evaluated in both groups. Results A total of 5,331 patients were included in this study, with 3,719 patients in the eradication group and 1,612 patients in the non-eradication group. Following H. pylori eradication, the chronic inflammation scores significantly decreased over time, with notable changes occurring in the early posteradication period(within 3 years). The atrophy score began to decrease at the 3-year mark, remained stable between 3 and 8 years, and significantly decreased after 8 years, with the average score decreasing from 1.46 ± 0.68 to 0.83 ± 1.05 ( p  = 0.005). The IM scores did not significantly improve in either group and gradually increased over time. However, from the 3-year follow-up onwards, the IM score in the eradication group stabilized. In the non-eradication group, the IM score exhibited a sustained upward trend starting from the 5-year, surpassing the eradication group by the 10-year ( p  = 0.237), peaking after 10 years (increasing from 1.06 ± 0.76 at baseline to 1.56 ± 0.87, p  < 0.001). Among the 293 patients who were eligible for OLGA and OLGIM staging, the proportions of patients with reduced OLGA stages in the short-(≤ 3 years), medium-༈3–8 years༉, and long-term༈>8 years༉ follow-up groups after H. pylori eradication were 59.81%, 43.08%, and 100%(3/3), respectively. Similarly, the proportions of patients with reduced OLGIM stages were 38.10%, 27.27%, and 75.00%, respectively. These proportions were greater than those in the non-eradication group, with all p values < 0.05, except for the long-term OLGIM follow-up group ( p  = 0.065). During the follow-up period, 68 patients developed gastric cancer, with the majority (80%) of cases occurring within 8 years posteradication. In contrast, 86.96% of the gastric cancer cases in the non-eradication group occurred within 5 years of follow-up, of which 43.48% occurred within the first 3 years. Additionally, the early gastric cancer detection rate was higher in the eradication group than in the non-eradication group (82.22% vs. 78.26%, p  < 0.001). Conclusion H.pylori eradication effectively improved chronic gastric mucosal inflammation, with gradual improvement and reversal of gastric mucosal atrophy over time, particularly after 8 years. Although the reversal of IM was limited, eradication could delay its progression. Nonetheless, there remains a risk of gastric cancer posteradication, especially within the first 5 years, underscoring the need for regular endoscopic surveillance.