to evaluate efficacy of ASA + PPI in comparison with PPI alone on the course of advanced gastritis.

during 5y period, every case of advanced gastritis including intestinal metaplasia (IM), mucosal atrophy or low grade dysplasia in a referral center included. All of the positive H Pylori cases got eradication then participants allocated to each groups of ASA 80mg + Pantoprazole 40mg or Pantoprazole alone. The participants followed by every 6months to 1 year endoscopy and gastric mapping. The histologic changes among two groups and any potential progression toward more advanced stages determined and compared.

overall 61 cases included. Average duration of follow up was 19.2 months (8 To 60). 26 cases reported as incomplete IM, 23 cases as complete IM, 9 cases as mild atrophy, 2 cases as moderate atrophy and one case as mild dysplasia. 54% of patients were H Pylori positive which received eradication. 22 cases allocated to group A (ASA + PPI) and rest of participants treated with PPI alone (group B). During follow up, overall 19 cases got improve based on pathology report, defined as complete resolution of IM or changing from sever to mild. 15 cases belonged to group B (PPI alone) and 4 cases in group A (PPI + ASA) (P= 0.09). During this period, 3 cases encountered deterioration as changing from mild to sever or recurrence of IM after previous resolution (2 in group A, 1 in group B). None of the cases evolved to gastric cancer or sever dysplasia during follow up.

long term acid suppression with PPI could be effective for prevention of IM aggravation but adding ASA have not any statistically significant positive effect.