Predictive factors and prevalence of follicular gastritis in adults with peptic ulcer and nonulcer dyspepsia

Follicular gastritis is an important histological entity, because it may pr ogress to overt gastric MALT lymphoma. However, there is no universal agree ment on whether there is any correlation of follicular gastritis with histo logical features of the antral mucosa or on the prevalence of follicular ga stritis. To shed further light on these issues, we studied antral biopsies obtained from 735 adult patients, who had participated in six consecutive c linical trials, They included 348 patients with duodenal ulcer, 82 with gas tric ulcer, and 305 with nonulcer dyspepsia, The Sydney classification syst em of gastritis was used, using a score of 0-3 to grade degree and activity of inflammation, gland atrophy, intestinal metaplasia, and H. pylori colon ization density. Follicular gastritis was defined as prominent lymphoid fol licles with no lymphoepithelial lesion. None of the H. pylori-negative pati ents (N = 159) had follicular gastritis. Among H. pylori-positive patients, 80/340 (23.5%) with duodenal ulcer, 5/77 (6.5%) with gastric ulcer, and 20 /159 (12.6%) with nonulcer dyspepsia had follicular gastritis (P < 0.001). Multivariate discriminant analysis selected the following four significant predictor variables for follicular gastritis (Wilks lambda = 0.91, x(2) 70. 6, df = 4, P < 0.001): gastritis sum score, atrophic gastritis, age of the patient, and disease. The prevalence of follicular gastritis was linearly c orrelated (y = 24.55 - 0.98x, r = -0.62, F-1,F-11 = 6.12, P 0.03) with the age groups of the 576 H. pylori-positive patients studied. In conclusion, f ollicular gastritis is highly correlated with H. pylori-caused severe, acti ve gastritis, It is mostly prevalent in the young H. pylori-infected patien ts with duodenal ulcer.