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. |
