title: Prevalence of gastric metaplasia in the duodenal bulb and distribution of Helicobacter pylori in the gastric mucosa. A clinical and histopathological study in 96 consecutive patients.
abstract: BACKGROUND
  Consecutive untreated patients with duodenal ulcer (n = 49) or gastric ulcer (n = 47) were compared with regard to the presence of gastric metaplasia in the duodenal bulb, gastric distribution of Helicobacter pylori and histopathological findings to assess differences which may contribute to either duodenal ulcer or gastric ulcer development.
  
  
  METHODS
  Serial sections of corpus, antral and duodenal mucosal biopsies were stained by haematoxylin-eosin stain for histopathological evaluation, immunohistochemistry for the detection of Helicobacter pylori, and duodenal biopsies alone by the PAS/Alcian blue stain to assess the presence of gastric metaplasia in the duodenal bulb.
  
  
  RESULTS
  Helicobacter pylori was found in 81.6% of duodenal ulcer and in 83.0% of gastric ulcer patients. In duodenal ulcer and gastric ulcer patients, Helicobacter pylori was found in 79.6% and 79.5% of corpus, 77.6% and 72.3% of antral, and 16.7% and 20.0% of duodenal bulb biopsies, respectively. In duodenal ulcer patients, the density of Helicobacter pylori was significantly lower in corpus compared to antrum biopsies (p < 0.001). Furthermore, the Helicobacter pylori density was higher in corpus of gastric ulcer than of duodenal ulcer patients. Inflammatory scores followed the density of Helicobacter pylori infection. In the duodenal bulb of both duodenal ulcer and gastric ulcer patients, the occurrence and extent of gastric metaplasia were comparable. Gastric metaplasia was present in 5 out of 8 Helicobacter pylori positive duodenal biopsies of duodenal ulcer patients and in 3 out of 9 Helicobacter pylori positive duodenal biopsies of gastric ulcer patients.
  
  
  CONCLUSIONS
  No evidence was found for a role of gastric metaplasia in the differential pathogenesis of duodenal ulcer or gastric ulcer. Differences in the gastric topography of Helicobacter pylori density and inflammatory scores between duodenal ulcer and gastric ulcer may contribute to differences in development and presentation of both peptic ulcer conditions.
authors.affiliation: Department of Gastroenterology, University Hospital Maastricht, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Jonkers
authors.forename: G
authors.initials: G
authors.lastname: Houben
authors.forename: A
authors.initials: A
authors.lastname: de Bruine
authors.forename: J W
authors.initials: JW
authors.lastname: Arends
authors.forename: E
authors.initials: E
authors.lastname: Stobberingh
authors.forename: R
authors.initials: R
authors.lastname: Stockbrügger
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000473:pathology*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000209:etiology / Q000473:pathology; D013276:Stomach Ulcer / Q000382:microbiology / Q000473:pathology*