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The LA classification for esophagitis: a call for standardization

Recently, it has been suggested (NEJM 1996;334:1018) that longterm, profound acid suppression hastens the development of atrophic gastritis in those infected withHelicobacter pylori(H. pylori). This, in turn, may facilitate the occurrence of intestinal metaplasia, dysplasia, and gastric cancer. However, this study has been criticized because of important methodological limitations. To further investigate this hypothesis, Lundell et al. conducted a prospective, randomized study comparing longterm proton pump inhibitor (PPI) therapy with antireflux surgery (ARS) in patients with gastroesophageal reflux disease (GERD). In this 3-yr interim analysis of a planned 5-yr study, baseline and 3-yr data were obtained in 131 ARS patients and 139 PPItreated patients. Forty PPI-treated patients were infected withH. pylori compared with 53 in the ARS group. After 3 yr of therapy, only slight changes in the prevalence of gastric body inflammation in theH. pyloriinfected patients were found. Furthermore, a slow progression of gastric glandular atrophy was observed in these same patients irrespective of their treatment. Finally, there was no difference between the groups in the development of intestinal metaplasia. The authors conclude that, in H. pylori -infected GERD patients, acidsuppressive therapy in the form of a PPI maintained for 3 yr hastens neither the development of atrophic gastritis nor the occurrence of intestinal metaplasia. We eagerly await the results of their continued follow-up of these patients in hopes that it will settle this issue once and for all.