Geographic differences in the distribution of intestinal metaplasia in duodenal ulcer patients.
OBJECTIVE
A strong correlation exists between atrophic gastritis and the intestinal type of gastric carcinoma. Duodenal ulcer disease characteristically has an antral predominant gastritis and a lower risk for gastric cancer. The aim of this study was to investigate the extent and distribution of intestinal metaplasia in duodenal ulcer in countries differing in gastric cancer incidence.


METHODS
Topographically mapped gastric biopsy specimens (median 11) were obtained from patients with duodenal ulcer in four countries (Korea, Colombia, USA, and South Africa). Sections were stained with a triple stain and evaluated for Helicobacter pylori (H. pylori), active inflammation, and intestinal metaplasia.


RESULTS
One hundred and sixty-five patients with duodenal ulcer were examined (29 from Korea, 52 from Colombia, 62 from the USA, and 22 from South Africa). The percentage of biopsies with intestinal metaplasia was significantly greater in Korean patients (86%) compared with that in other countries (50%) (p = 0.0004). Intestinal metaplasia was most prevalent in the antrum lesser curve and greater curve, and the body lesser curve. Intestinal metaplasia was present in the gastric corpus of 38% of duodenal ulcer patients from Korea compared with an average of 10% elsewhere (p = 0.018). No differences were observed in the density or distribution of H. pylori infection or in the degree of active gastritis between countries.


CONCLUSIONS
Although antral predominant gastritis is the prevalent pattern of gastritis in duodenal ulcer, intestinal metaplasia in the gastric corpus may be found with geographic differences. These findings suggest that duodenal ulcer and gastric cancer are not mutually exclusive diseases but are rather ends of the spectrum of H. pylori infection.
Department of Medicine, VA Medical Center, Baylor College of Medicine, Houston, Texas 77030, USA.
El-Zimaity HMT
O
O
Gutierrez
J G
JG
Kim
T
T
Akamatsu
I E
IE
Gürer
A E
AE
Simjee
D Y
DY
Graham
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D003105:Colombia; D004381:Duodenal Ulcer / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005756:Gastritis / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007422:Intestines / Q000473:pathology*; D007723:Korea; D008297:Male; D008679:Metaplasia / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D013019:South Africa; D014481:United States