Subtypes of intestinal metaplasia and Helicobacter pylori

Abstract

To determine whether there is a relationship between the presence of H pylori and the various subtypes of intestinal metaplasia in the gastric antrum, 2274 antral gastroscopic biopsies from 533 patients were examined. H pylori was found in 289 patients. Intestinal metaplasia in general was found in 135 patients. Type I intestinal metaplasia was found in 133 patients (98·5%), type II in 106 patients (78·5%) and type III in 21 patients (15·6%). Ninety eight of these 135 patients (72·6%) were H pylori positive and 37 patients (27·4%) were H pylori negative. No statistically significant difference was found in the prevalence of type I and II intestinal metaplasia between the intestinal metaplasia positive and H pylori positive and intestinal metaplasia negative and H pylori negative patients. Type III intestinal metaplasia was found less often in the intestinal metaplasia positive and H pylori positive patients (11·2%) as compared with intestinal metaplasia positive and H pylori negative patients (27%) (p<0·05). In contrast with type I and II intestinal metaplasia type III intestinal metaplasia was found more often in moderate/ severe intestinal metaplasia than in mild intestinal metaplasia (p<0·02). Within the group of patients with moderate/severe intestinal metaplasia, type III was found less often in the H pylori positive patients (p<0·05). We suggest that the gastric milieu for H pylori is less appropriate in type III intestinal metaplasia positive patients. As type III intestinal metaplasia might be regarded as a marker of possibly increased gastric cancer risk, the lower prevalence of H pylori in these type III intestinal metaplasia positive patients might be the result of severe changes in mucosal architecture.