Geographic differences in the distribution of intestinal metaplasia in duodenal ulcer patients

OBJECTIVE: A strong correlation exists between atrophic gastritis and the i ntestinal type of gastric carcinoma. Duodenal ulcer disease characteristica lly has an antral predominant gastritis and a lower risk for gastric cancer . The aim of this study was to investigate the extent and distribution of i ntestinal metaplasia in duodenal ulcer in countries differing in gastric ca ncer incidence. METHODS: Topographically mapped gastric biopsy specimens (median II) were o btained from patients with duodenal ulcer in four countries (Korea, Colombi a, USA, and South Africa). Sections were stained with a triple stain and ev aluated for Helicobacter pylori (H. pylori), active inflammation, and intes tinal metaplasia. RESULTS: One hundred and sixty-five patients with duodenal ulcer were exami ned (29 from Korea, 52 from Colombia, 62 from the USA, and 22 from South Af rica). The percentage of biopsies with intestinal metaplasia was significan tly greater in Korean patients (86%) compared with that in other countries (50%) (p = 0.0004). Intestinal metaplasia was most prevalent in the antrum lesser curve and greater curve, and the body lesser curve. Intestinal metap lasia was present in the gastric corpus of 38% of duodenal ulcer patients f rom Korea compared with an average of 10% elsewhere (p = 0.018). No differe nces were observed in the density or distribution of H. pylori infection or in the degree of active gastritis between countries. CONCLUSIONS: Although antral predominant gastritis is the prevalent pattern of gastritis in duodenal ulcer, intestinal metaplasia in the gastric corpu s may be found with geographic differences. These findings suggest that duo denal ulcer and gastric cancer are not mutually exclusive diseases but are rather ends of the spectrum of H, pylori infection. (C) 2001 by Am. Cell. o f Gastroenterology.