Korean J Gastroenterol.  2013 Apr;61(4):191-195. 10.4166/kjg.2013.61.4.191.

Helicobacter pylori Infection and Duodenal Gastric Metaplasia in Healthy Young Adults

• Seo JH
• Do HJ
• Park CH
• Woo HO
• Youn HS
• Ko GH
• Baik SC
• Lee WK
• Cho MJ
• Rhee KH
• Lee JH

• KMID: 1775757
• DOI: http://doi.org/10.4166/kjg.2013.61.4.191

Abstract

BACKGROUND/AIMS
Duodenal ulcers occur relatively frequently in adolescents, like in adults, and may relate to Helicobacter pylori infection and duodenal gastric metaplasia (DGM). This study investigated the association between H. pylori infection and DGM in healthy adults aged 20-29.
METHODS
Between 1995 and 2005, endoscopic biopsies of the duodenum, antrum and body were taken from healthy, young volunteers, who were first-year medical students, faculty staff, residents, and research assistants of Gyeongsang National University in Jinju, Korea. Urease tests were performed and the extent of DGM and histopathological grades according to the Updated Sydney System were determined.
RESULTS
In total, 662 subjects were enrolled (429 males and 233 females). The median age was 22.3 years. The overall incidence of DGM was 11.5% but DGM was more frequent in males (15.4%) than in females (4.3%) (p<0.0001). While H. pylori positivity rates changed significantly during the 1995-2005 period (p<0.01), the incidences of DGM did not. DGM was observed in 7.2% and 14.9% of subjects who were and were not colonized with H. pylori, respectively. DGM was also associated with less severe chronic gastritis and the absence of active gastritis in both the antrum and body, and the absence of follicles in the antrum (p<0.05).
CONCLUSIONS
These findings suggested that DGM is not rare in healthy young adults and is unrelated to gastric H. pylori infection.

Keyword

Helicobacter pylori; Metaplasia; Adult

MeSH Terms

Adult
Age Factors
Duodenum/*pathology
Female
Gastric Mucosa/*pathology
Helicobacter Infections/complications/*diagnosis/epidemiology
*Helicobacter pylori
Humans
Male
Metaplasia/complications/*diagnosis/epidemiology
Pyloric Antrum/*pathology
Severity of Illness Index
Sex Factors
Young Adult

Figure

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  Fig. 1. Rates of Helicobacter pylori positivity in the gastric antrum and duodenal gastric metaplasia throughout an 11-year study period (1995–2005). H. pylori positivity (as determined by histologic degree of H. pylori density) decreased significantly over the 11-year period (p＜0.05) but the incidence of duodenal metaplasia did not change (p=0.085).

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  Fig. 2. Degree of duodenal gastric metaplasia in healthy, young subjects divided by gender. a p＜0.0001: males differed significantly from females in their incidences of mild and moderate duodenal gastric metaplasia.

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  Fig. 3. The duodenal, antral and body urease grade data of the subjects, who are divided according to both the degree and presence/absence of duodenal gastric metaplasia. Urease test results are expressed as grade 0 (no change of color), grade 1 (color change between 24–48 hours), grade 2 (color change between 6–24 hours), and grade 3 (color change within 6 hours). Significant differences: a p=0.0002; b p=0.0003.

Reference

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