Gastric metaplasia and chronic inflammation at the duodenal bulb mucosa.
BACKGROUND
Chronic inflammation and gastric metaplasia are often observed in biopsy specimens from the duodenal bulb of Heliobacter pylori positive patients with duodenal ulcer disease (DU).


OBJECTIVE
We set out to investigate the prevalence of these lesions and their associations with other gastric and duodenal histopathological lesions.


METHODS
A total of 1255 consecutive patients who underwent upper gastrointestinal endoscopy were recruited into the present study.


METHODS
Two biopsy specimens were obtained from each of the following sites: duodenal bulb, gastric antrum, gastric body, and distal to the superior duodenal angle. These specimens were stained with hematoxylin-eosin, alcian blue periodic acid Schiff (pH 2.5) and modified Giemsa (Heliobacter pylori infection was determined only by histology).


RESULTS
The mean age of the study population was 57 years, and male:female ratio 1:1.6. Overall, 235 (19%) had gastric metaplasia and/or chronic inflammation in the duodenal bulb mucosa, and H. pylori organisms could be found in 17 (1%). In univariate analyses, gastric metaplasia and/or chronic duodenal bulb inflammation positively associated with male sex (p = 0.046), Heliobacter pylori-positive chronic gastritis (p = 0.033), villous atrophy of distal duodenal mucosa, i.e., coeliac disease (p < 0.001), duodenal ulcer (p < 0.001), and duodenal bulb deformity and scarring in endoscopy (p < 0.001), but not with age (p = 0.7) nor use of nonsteroidal anti-inflammatory drugs (p = 0.055). Multivariate analysis revealed that independent risk factors for gastric metaplasia and chronic inflammation in duodenal bulb were duodenal Heliobacter pylori infection (odds ratio 1.6, 95% confidence interval CI 1.1-2.1), and villous atrophy of the distal duodenal mucosa (odds ratio 12.7, 95% CI 4.4-36.5), while chronic atrophic gastritis was protective against them (odds ratio 0.5, 95% CI 0.3-0.8).


CONCLUSIONS
In addition to Heliobacter pylori infection, duodenal bulb gastric metaplasia and chronic inflammation may result from predisposition to toxic dietary components in gluten-sensitive subjects.
South Karelia Central Hospital, Department of Internal Medicine, Valto Käkelän katu 14 A, FIN-53130 Lappeenranta, Finland. markku.voutilainen@ekshp.fi
M
M
Voutilainen
M
M
Juhola
M
M
Färkkilä
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P
Sipponen
D002908:Chronic Disease; D004381:Duodenal Ulcer / Q000382:microbiology* / Q000473:pathology*; D004382:Duodenitis / Q000382:microbiology / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005756:Gastritis / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000473:pathology*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008679:Metaplasia; D008875:Middle Aged