Gastric metaplasia and Campylobacter pylori in duodenal ulcer disease: an ultrastructural analysis.
An ultrastructural analysis was carried out on duodenal mucosa specimens, obtained during duodenoscopy from the edge of ulcers and distal duodenal cap mucosa in 42 patients with active duodenal ulcer disease, and in 12 controls. In 18 of 42 patients (43 p. 100), Campylobacter pylori was found in duodenal mucosa but not in controls (chi 2 = 5.91, p less than 0.05). In all 42 cases, gastric-type surface mucus cells were seen at the edge of the ulcer crater, and in 38 of the patients (90 p. 100) these metaplastic cells were also seen in the distal duodenal cap. C. pylori was always localized within the mucus layer, frequently in the intercellular spaces and, in 4 of 18 cases (22 p. 100), within the cytoplasm. C. pylori was detected exclusively in the proximity of gastric type metaplastic surface mucus cells with apparent fusion of membranes. It is suggested that the metaplastic surface mucus cell in the duodenal epithelium of patients with active duodenal ulcer disease is the target cell for colonization by C. pylori.
Malfertheiner
P
P
Department of Internal Medicine II, University of Ulm, FRG.
Bode
G
G
Stanescu
A
A
Ditschuneit
H
H
D000328:Adult; D000368:Aged; D002169:Campylobacter Infections / Q000473:pathology*; D004381:Duodenal Ulcer / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia; D008854:Microscopy, Electron; D008875:Middle Aged