ADHERENCE OF HELICOBACTER-PYLORI TO AREAS OF INCOMPLETE INTESTINAL METAPLASIA IN THE GASTRIC-MUCOSA

Background & Aims: Helicobacter pylori is not usually found in areas o f intestinal metaplasia. Thus, the development of intestinal metaplasi a has been viewed as a mechanism by which the stomach eliminates H. py lori. The aim of this study was to evaluate the frequency of H. pylori adherence to intestinal metaplasia in different populations. Methods: Mapped gastric biopsy specimens from 378 H. pylori-positive subjects from various geographical regions were examined. Intestinal metaplasia was typed by staining with periodic acid-Schiff/alcian blue and high- iron diamine/alcian blue. Results: In 32 patients, H. pylori was found in intimate contact with intestinal metaplasia. This was documented b y electron microscopy. AII areas of intestinal metaplasia showing adhe rence contained sulfomucins and had no brush border. Posttreatment bio psy specimens from 4 patients whose infection was not cured showed per sistence of H. pylori in intestinal metaplasia. Conclusions: These pat ients may have a strain of H. pylori with unusual adhesion characteris tics, or their type of intestinal metaplasia may have biochemical prop erties that make it hospitable for H. pylori. The exclusive associatio n of H. pylori adherence with incomplete intestinal metaplasia (a puta tive precursor of carcinoma) and its greater frequency in Koreans (a p opulation at risk for gastric cancer) suggest that this phenomenon may play a role in the hypothetical sequence metaplasia > dysplasia > car cinoma.