GASTRIC METAPLASIA OF REGENERATING DUODENAL MUCOSA AND DEFORMITY OF DUODENAL BULB - A CORRELATIVE STUDY

The correlation between the presence and degree of gastric metaplasia of regenerating duodenal mucosa and the deformity of duodenal bulb was studied. Based on the endoscopically morphological patterns of bulb, the duodenal ulcers were divided into three types: type I, with a norm al-shaped bulb; type II, with a mildly deformed bulb; and type III, wi th a markedly deformed bulb. A total of 159 patients with active duode nal ulcers were scheduled to be treated with H-2-receptor antagonists. Of these patients, 124 proved to have a healed duodenal ulcer 4 weeks after initial treatment upon follow-up endoscopic examinations. Two b iopsies were taken from the centre of the ulcer scar when the ulcer wa s found to be healed for light microscopic study. Histologically, the degree of gastric metaplasia was divided into three grades: grades 0, 1 and 2. The results show that a healed duodenal ulcer with a normal-s haped bulb is not frequently accompanied by gastric metaplasia. Howeve r, a healed ulcer with a markedly deformed bulb has a high incidence a nd degree of gastric metaplasia, which may be easily colonized by Heli cobacter pylori and thus develop an environment of easy recurrence. Th erefore, a cycle of healing and recurrence may exist in patients with a duodenal ulcer and a markedly deformed bulb. Eradication of H. pylor i may be the best way to break this cycle.