Relationship of duodenal ulcer recurrence to gastric metaplasia of the duodenal mucosa and duodenal bulb deformity

Background and Purpose: This study investigated changes in the severity of gastric metaplasia (GM) of the duodenal mucosa before and after ulcer heali ng and Helicobacter pylori cradication. It also investigated whether deform ity of the duodenal bulb affects the severity of GM and the likelihood of u lcer recurrence. Methods: Eleven patients were consecutively enrolled in this study. They al l had duodenal ulcer(s) and H. pylori infection, for which they had receive d anti-H. pylori triple therapy during the active ulcer stage, and had all undergone serial endoscopic examinations during both the active ulcer and s carring ulcer stages, and at 1 year after ulcer healing. Duodenal biopsies were obtained at each endoscopy to identify the severity of GM. Duodenal ul cers were divided into three types by bulbar shape and GM was classified in to foul grades of severity. Results: All 11 patients had increased GM severity just after ulcer healing . Tile 1-year follow-up study revealed that the GM was unchanged in sis of eight patients with grade 3 GM severity at the scarring stage, while ill th e other two it regressed to grade 1 or 2; these two patients suffered ulcer recurrence. A markedly deformed bulb (type III) was found in three patient , of whom two had ulcer recurrence. Conclusion: Two characteristic conditions were found in patients with duode nal ulcer recurrence after H. pylori eradication: a markedly deformed bulb x ith grade 3 GM at the scarring stage, and a change in GM from high to low grade at all around the previous ulcer sire after ulcer healing.