The course of gastric type epithelium in duodenal ulcer and duodenitis; role on the eradication of Helicobacter pylori

Abstract

The course of gastric type epithelium during the healing process and beyond the scarring stage of duodenal ulcer was studied in patients with and without Helicobacter pylori (H. pylori) eradication. Materials were consist of 110 patients with active H. pylori ulcers, 27 patients with H. pylori positive ulcer scars and 6 patients with active H. pylori positive duodenitis. The results obtained were as follows. 1) In the non-eradication group, the degree of gastric type epithelium increased as the ulcers healed, but gastric type epithelium remained immature compared with the eradication group. 2) In the non-eradication group, the degree of gastric type epithelium decreased subsequently with or without recurrence of the duodenal ulcer. Under H. pylori positive condition, the degree of gastric type epithelium appeared to be reduced because of invasion by H. pylori. When this condition continued, ulcers probably recurred because of diminished defences against acid in damaged areas of gastric type epithelium. 3) In the successful eradication group, gastric type epithelium became well developed and mature state (grade 4), and remained in this condition for long period because it was not invaded by H. pylori. The appearance of mature state of gastric type epithelium appears to play a role in the prevention of ulcer recurrences by maintaining an adequate defence mechanisms against acid. 4) In the unsuccessful eradication group, the degree of gastric type epithelium remained lower mature state than that of successful eradication group. 5) In cases of H. pylori positive ulcer scar, the degree of gastric type epithelium reached also well developed and mature state when H. pylori was successfully eradicated, and maintained in this condition for a prolonged period. Ulcer recurrence was not observed. 6) In case of H. pylori positive duodenitis, the degree of gastric type epithelium reached mature state after successful eradication, and endoscopic findings of inflammation was improved.