THE ROLE OF HELICOBACTER PYLORI INFECTION IN GASTRIC MUCOSAL ANTRALIZATION AND METAPLASIA
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Helicobacter Pylori is a carcinogen: gastric carcinoma involves a multistep process from chronic gastritis to atrophy. intestinal metaplasia, and dysplasia. The aims of this study were to determine the types of mucosa at different gastric sites in H. pylon-infected and uninfected patients, and whether the presence of antral-type mucosa in the incisura, body, and tondos is associated with gastric atrophy and intestinal metapiasia. Methods : Two hundred and sixty-eight patients with dyspepsia were enrolled. Eight biopsies (i.e., antrum X3. body X2, tondos X2, and incisura X1) were obtained. One antral biopsy was used for a rapid urease test. The remaining biopsies were examined histologically according to the updated Sydney System after staining with hematoxylin and eosin and Giemsa. Results : Overall, 113 (42%) patients were infected with H. pylori. At the incisura, antral-type mucosa was more prevalent in infected than in unifected patients (84% vs 18%; odds ratio PRI = 23.9. 95% confidence interval 12.5-45.8; p<0.001). Atrophic gastritis and intestinal metaplasia at the incisura was present in 19.5% and 13.3%, respectively, of infected, and 4.5% and 3.2%. respectively, of uninfected patients (both p <0.01). Moreover, atrophic gastritis at the incisura was associated with the presence of antral-type mucosa at the site (termed antralization): the prevalence of atrophic gastritis was 19.5% (24/123) in the presence of antralization. whereas the rate was 2.1% (3 / 145) without antralization (OR = 11.4. 95% Cl 3.4-39.2: Pc 0.001). Similarly, at the incisura. 16.396 (20/123) of antralized cases and 1.4% (2 / 145) of unantralized cases had intestinal metaplasia (OR = 13.8. 95% a 3.2 - 60.7: p < 0.001). The association between antralization at gastric body and fundus also appeared to be associated with atrophic gastritis and intestinal metaplasia at these sites. Conclusions: Atrophic gastritis and intestinal metaplasia occurs predominantly at the gastric antrum and incisura with H. pylon infection. Antralization of gastric incisura is a common event in H. pylon-infected patients, and appears to be associated with an increased risk of atrophic gastritis and intestinal metaplasia.