HELICOBACTER-PYLORI AND INTESTINAL METAPLASIA - COMPARISON BETWEEN BRITISH AND YEMENI PATIENTS

There have been suggestions linking gastric carcinoma with Helicobacte r pylori on the one hand and type Ill intestinal metaplasia on the oth er hand. This study was aimed at investigating the relationship betwee n intestinal metaplasia and its subtypes, and the presence or absence of H. pylori in gastric biopsies from two geographically different pat ient populations, one with a much higher prevalence of H. pylori than the other. Antral biopsies from 179 British and 123 Yemeni patients wi th dyspepsia were examined. Sections stained with hematoxylin and eosi n, Alcian blue/periodic acid-Schiff, high iron diamine/Alcian blue, an d Warthin-Starry stains were used to assess the presence or absence of inflammation, H. pylori, and intestinal metaplasia with its three sub types. Although Yemeni patients had a significantly higher prevalence of H. pylori than British patients (113/123. 92% vs. 83/179, 46% respe ctively; p < 0.001), Yemeni patients had a significantly lower prevale nce of all types of intestinal metaplasia (23/123, 19% vs. 60/179, 34% ; p < 0.001), as well as type III metaplasia (4/123, 3% vs. 39/179, 22 %, p < 0.001). These trends persisted when only patients above the age of 40 yr were considered. However, in British patients, intestinal me taplasia was more commonly seen in those with H. pylori than in those without (36/83, 43%, and 24/96, 25%, respectively, p < 0.01), although the prevalence of type III metaplasia was not significantly different in the two groups (23/83, 28% vs. 16/96, 17%, respectively). The cont rasting findings in the two patient populations suggest the presence o f other factors, possibly genetic, which control the development of in testinal metaplasia and possibly gastric carcinoma in H. pylori-positi ve patients.