Helicobacter pylori infection, gastric metaplasia in the duodenum and the relationship with ulcer recurrence

Objective To study the prevalence of Helicobacter pylori (H, pylori) infect ion and gastric metaplasia (GM) in the duodenum a large group of patients w ith duodenal ulcer was evaluated to determine whether these factors are rel ated to the number of ulcer recurrences. Methods Three hundred and seven patients diagnosed by endoscopy as having a ctive duodenal ulcers were studied. At endoscopy, all patients had gastric biopsies taken for histology, the rapid urease test and culture. Three duod enal biopsies were also taken and processed for histology (haematoxylin & e osin, Giemsa, Warthin-Starry, and PAS stain). Results GM and H. pylori in the duodenum was identified in 73% (68-78%) and 66% (60-71%) of the cases, respectively, All patients with H. pylori in th e duodenum also had GM at this location, while areas with GM but without H. pylori were described, The kappa statistic for concordance between GM and H pylori at the duodenum was 0.82. The prevalence of GM and H. pylori, depe nding on the number of ulcer recurrences, was: Ist episode, 34% and 27%, re spectively; 2nd episode, 84% and 80%; and greater than or equal to 3rd epis ode, 90% and 79% (P < 0.001 when comparing 1st vs 2nd or <greater than or e qual to>3rd episode). In the multivariate analysis, age and number of ulcer recurrences correlated both with GM and with H pylori in the duodenum. Chr onic duodenitis was demonstrated in all duodenal biopsies, 87% being active chronic duodenitis. H. pylori in the duodenum was more frequent in patient s with active duodenitis (73%) than in those with inactive duodenitis (13%) (P < 0.001). Conclusions Patients with recurrent ulcer disease have a higher prevalence of both GM and H pylori infection in the duodenum, suggesting that these tw o factors are related with the chronicity and recurrence of duodenal ulcer disease. H pylori infection in the duodenum always appears in areas of GM, although GM is not necessarily colonized by the organism, H. pylori infecti on cannot be excluded based only on the results of duodenal biopsies, as fa lse negative results at this area are frequent, Eur J Gastroenterol Hepatol 12:1295-1298 (C) 2000 Lippincott Williams & Wilkins.