Abstract
Background: It has long been suspected that duodenogastric reflux plays a role in the pathogenesis
of intestinal metaplasia (IM), although recent studies have demonstrated a close association
between Helicobacter pylori infection and gastroduodenal diseases, including IM. The objective of this study
was to investigate the relation among IM and duodenogastric reflux, H pylori infection, and smoking. Methods: Subjects with “marked” characteristics of IM, all with extensive prepyloric distribution
at endoscopy that was confirmed histologically, were studied as an IM group (27 men,
26 women; mean age, 64 years). A control group was comprised by subjects without characteristics
of IM (29 men, 28 women; mean age, 63 years). Fasting pH, total bile acid concentration,
and ammonia concentration were measured in the gastric juice of all participants.
Histologic examination endoscopic biopsy specimens were evaluated histologically.
H pylori infection was determined by serum antibody and urease testing, and by histology.
Serum gastrin and pepsinogen concentrations, and gastric emptying time were measured.
Dietary, drinking, and smoking habits were recorded. Comparisons were made between
groups and analyzed statistically. Results: The pH and total bile acid concentrations were significantly higher in the IM group
than the control group (p < 0.01). No significant difference in H pylori infection was found between the IM and control group. Smoking was associated with
IM (odds ratio [OR], 15.74; 95% CI, 3.96 to 62.50). Conclusions: A high pH and total bile acid concentration and smoking were associated with “marked”
IM, suggesting that these factors may play a role in the development of IM. (Gastrointest
Endosc 2001;53:53-9.)
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References
- Intestinal metaplasia of gastric mucosa.Br J Cancer. 1955; 9: 365-376
- Carcinoma arising from areas of intestinal metaplasia in gastric mucosa.Br J Cancer. 1955; 9: 377-385
- A human model of gastric carcinogenesis.Cancer Res. 1988; 48: 1319-1326
- The etiology of gastric cancer.J Natl Cancer Inst. 1983; 71: 629-647
- Helicobacter pylori infection and gastric neoplasia: correlations with histological gastritis and tumor histology.Am J Gastroenterol. 1998; 93: 1271-1276
- Atrophic gastritis and intestinal metaplasia in asymptomatic Hungarian and Italian populations.Endoscopy. 1980; 12: 105-108
- Unidentified curved bacilli on gastric epithelium in active chronic gastritis.Lancet. 1983; 1: 1273-1275
- The Sydney System. A new classification of gastritis.J Gastroenterol Hepatol. 1991; 6: 207-252
- Campylobacter pylori in a sample of Finnish population: relations to morphology and functions of gastric mucosa.Gut. 1988; 29: 909-915
- Campylobacter pylori and chronic gastritis.in: Campylobacter pylori and gastroduodenal disease. : Blackwell Scientific Publications, London1992: 106-116
- Bile reflux and degree of gastritis in patients with gastric ulcer, before and after operation.J Surg Research. 1984; 37: 277-284
- Relationship between histology and gastric juice pH and nitrite in the stomach after operation for duodenal ulcer.Gut. 1984; 25: 246-252
- Gastric juice bile acids and scintigraphy in the assessment of duodenogastric reflux [abstract].Gut. 1984; 25: A1183
- Intragastric bile acids and histological changes in gastric mucosa.Br J Surg. 1986; 73: 354-356
- Bile reflux and intestinal metaplasia in gastric mucosa.J Clin Pathol. 1993; 46: 235-240
- Bile reflux is increased in cigarette smokers.Gastroenterology. 1986; 90: 1205-1209
- Smoke and chronic gastritis.Mount Sinai J Medicine. 1982; 49: 475-478
- Impact of diet and smoking on risk of developing intestinal metaplasia of the stomach.Dig Dis Sci. 1990; 35: 433-438
- A study of incidence and relationship of intestinal metaplasia of gastric antrum and gastric metaplasia of duodenum in patients with nonulcer dyspepsia.Dig Dis Sci. 1984; 29: 311-316
- Effect of cigarette smoking on extent of acid-secreting area and in the stomach.Dig Dis Sci. 1988; 33: 23-29
- Aetiological factors in chronic atrophic gastritis.Br Med J. 1966; 2: 1409-1415
- Diet and chronic atrophic gastritis.J Natl Cancer Inst. 1986; 76: 621-627
- Direct spectrophotometry of total bile acids in serum.Clin Chem. 1981; 27: 1352-1356
- Determination of the concentration of ammonia in plasma by means of direct color reaction method [Japanese].Saishin-Igaku. 1966; 21: 622-627
- Helicobacter pylori infection is the major risk factor for atrophic gastritis.Am J Gastroenterol. 1996; 91: 959-962
- Gastric emptying in normal subjects and patients with peptic ulcer. A study using acetaminophen method.Jpn J Gatroenterol. 1979; 14: 1-10
- Relation of Campylobacter pyloridis to gastritis and peptic ulcer.J Infect Dis. 1986; 153: 664-669
- Subtypes of intestinal metaplasia and Helicobacter pylori.Gut. 1992; 33: 597-600
- An experimental study of the relation of bile to ulceration of the mucous membrane of the stomach.J Med Res. 1914; 30: 147-184
- Histopathogenesis of intestinal metaplasia: minute lesions of intestinal metaplasia in ulcerated stomachs.J Clin Pathol. 1987; 40: 13-18
- Intestinal metaplasia of the regenerative epithelia in 549 gastric ulcers.Hum Pathol. 1983; 14: 1066-1071
- Variants of intestinal metaplasia in the evolution of chronic atrophic gastritis and gastric ulcer. A follow-up study.Gut. 1990; 31: 1097-1104
- Gastric epithelium in the duodenum: its association with Helicobacter pylori and inflammation.J Clin Pathol. 1990; 43: 981-986
- Ingestion of Campylobacter pyloridis causes gastritis and raised fasting gastric pH.Am J Gastroenterol. 1987; 82: 192-199
- Campylobacter pylori und gastritis—Beseidelungsdichte und Grad der Entzundung. Semiquantitative und morphometrische Untersuchung.Leber Magen Darm. 1989; 19: 70-78
- Differences in Helicobacter pylori associated gastritis in the antrum and body of the stomach.Z Gastroenterol. 1990; 28: 229-233
- Campylobacter-like organisms and reflux gastritis.J Clin Pathol. 1986; 39: 531-534
- Chronic gastritis—A pathogenetic approach.J Pathol. 1988; 154: 113-124
- Helicobacter pylori infection and serum pepsinogen A, pepsinogen C, and gastrin in gastritis and peptic ulcer: significance of inflammation and effect of bacterial eradiation.Am J Gastroenterol. 1994; 89: 1211-1218
- The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis.Helicobacter. 1999; 4: 40-48
- Serum pepsinogen as a screening test of extensive chronic gastritis.Gastroenterol Jpn. 1987; 22: 133-141
- Relationship among serum pepsinogen 1 and serum pepsinogen 2, and gastric mucosal histology. A study in relatives of patients with pernicious anemia.Gastroenterology. 1982; 83: 204-209
- Dietary determinants of gastric cancer in south Louisiana inhabitants.J Natl Cancer Inst. 1985; 75: 645-654
- Diet and cancer of stomach: a case-control study in China.Int J Cancer. 1988; 41: 331-335
- A case-control study of gastric cancer in northern Italy.Int J Cancer. 1987; 40: 484-489
- A case-control study of dietary factors and stomach cancer risk in Poland.Int J Cancer. 1986; 37: 837-842
- Wine and tobacco: risk factors for gastric cancer in France.Am J Epidemiol. 1981; 113: 668-674
- Histological and histochemical findings of the gastric mucosa in duodenal regurgitation.Endoscopy. 1975; 7: 68-71
- Effect of cigarette smoking on competence of the pylorus: preliminary study.Br Med J. 1973; 3: 313-316
- Effect of cigarette smoking on antroduodenal motility [abstract].Gastroenterology. 1992; 102: A457
Article Info
Publication History
Accepted:
September 7,
2000
Received in revised form:
July 10,
2000
Received:
May 5,
2000
Footnotes
☆Supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan.
☆☆Reprint requests: Ken Haruma, MD, First Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
★Gastrointest Endosc 2001;53:53-9
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
