Helicobacter pylori associated gastric intestinal metaplasia: Treatment and surveillance

Table 1 Recommended first and second line Helicobacter pylori eradication regimen

	1st line regimen	2nd line regimen
Japan[15]	PPI, amoxicillin 750 mg, clarithromycin 200 mg to 400 mg twice daily	PPI, amoxicillin 750 mg, metronidazole 250 mg twice daily
	Duration: 7 d	Duration: 7 d
Korea[14]	PPI, amoxicillin 1 g, clarithromycin 500 mg twice daily	PPI, bismuth 120 mg four times daily, tetracycline 500 mg four times daily, metronidazole 500 mg three times daily
	Duration: 7-14 d	Duration: 7-14 d
Europe[16]	PPI-clarithromycin containing triple therapy OR	Bismuth-containing quadruple therapy OR levofloxacin-containing triple
	Bismuth or non-bismuth containing quadruple1
	Duration: 7-14 d	Duration: 10 d
China[13]	No preferential choice. Options include: (1)PPI, amoxicillin 1 g, clarithromycin 500 mg twice daily (2) PPI, amoxicillin 1 g, levofloxacin 200 mg twice daily (or levofloxacin 500 mg daily) (3) PPI, amoxicillin 1 g, furazolidone 100 mg twice daily (4) PPI, tetracycline 750 mg, metronidazole 400 mg twice daily (or metronidazole 400 mg three times per day) (5) PPI, bismuth 220 mg plus any of the two antibiotics above twice daily
	Duration: 7-14 d

¹Bismuth quadruple or non-bismuth quadruple (sequential or concomitant) as the preferred choice in regions with high clarithromycin resistance profile (> 20%). Choice of PPI includes lansoprazole 30 mg, omeprazole 20 mg, rabeprazole 20 mg, esomeprazole 20 mg, or pantoprazole 40 mg. PPI: Proton pump inhibitor.

Table 2 Operative Link for Gastritis Assessment[31]

	Corpus
	No atrophy (score 0)	Mild atrophy (score 1)	Moderate atrophy (score 2)	Severe atrophy (score 3)
Antrum (including incisura angularis)
No atrophy (score 0)	Stage 0	Stage I	Stage II	Stage II
Mild atrophy (score 1)	Stage I	Stage I	Stage II	Stage III
Moderate atrophy (score 2)	Stage II	Stage II	Stage III	Stage IV
Severe atrophy (score 3)	Stage III	Stage III	Stage IV	Stage IV

Table 3 Pharmacological treatment of gastric intestinal metaplasia

Ref.	Intervention	Study design	Countries	Number of patients	Results
Kong et al[38], 2014	H. pylori eradication	Meta-analysis of 16 trials (including 1 RCT and 15 observational studies)	China, Japan, Italy and Columbia	3432	Antral IM: pooled WMD with 95%CI: 0.23 (0.18-0.29)
					Corpus IM: pooled WMD with 95%CI: -0.01 (-0.04-0.02)
Leung et al[42], 2006	Rofecoxib for 24 mo	RCT (vs placebo)	China	213 after H. pylori eradication	Antrum IM regression: 24.5% vs 26.9% in placebo
					Corpus IM regression 4.3% vs 2.2% in placebo
Wong et al[43], 2012	Celecoxib for 24 mo	RCT (H. pylori eradication, celecoxib or both)	China	1024 H. pylori positive	OR for regression of gastric lesions 1.72 (95%CI: 1.07-2.76)
You et al[44], 2006	Vitamins or Anti-oxidants	RCT (H. pylori eradication, vitamins or garlic supplements)	China	3365	Both vitamins and garlic supplements have no effect on gastric precancerous lesion

H. pylori: Helicobacter pylori; RCT: Randomized controlled trial; WMD: Weighted mean difference.