Gastroenterology

Gastroenterology

Volume 139, Issue 6, December 2010, Pages 1894-1901.e2
Gastroenterology

Clinical—Alimentary Tract
A National Study of Helicobactor pylori Infection in Gastric Biopsy Specimens

https://doi.org/10.1053/j.gastro.2010.08.018Get rights and content

Background & Aims

We investigated whether infection with Helicobacter pylori and signs of chronic active gastritis and intestinal metaplasia in gastric biopsy samples were inversely associated with Barrett's metaplasia.

Methods

We studied gastric biopsy samples from 78,985 unique patients. Histologic findings were correlated with sociodemographic patient characteristics using multivariate logistic regression to calculate odds ratios and 95% confidence intervals.

Results

H pylori infection, chronic active gastritis, and intestinal metaplasia had similar epidemiologic patterns. The presence of each, based on histology analyses, was significantly associated with that of the others. They were also characterized by similar geographic distributions within the United States. All 3 disorders were more common among men and among Medicaid patients (compared with those with other insurance) and were inversely associated with Barrett's metaplasia (less frequent in patients with Barrett's metaplasia).

Conclusions

H pylori infection and associated disorders, such as chronic active gastritis and intestinal metaplasia, are inversely associated with Barrett's metaplasia.

Section snippets

Data Source

The present study was conducted at Caris Life Sciences, a specialized gastrointestinal laboratory, operating in private outpatient endoscopy centers distributed throughout the United States. The results of all surgical pathology were stored in a single electronic database. Besides demographic characteristics, each patient record also contained the clinical and endoscopic diagnoses, as well as a detailed list of all results of surgical pathology. Surgical pathology diagnoses were coded in a

Results

The 4 panels of Figure 1 depict the age distributions associated with the 4 histologic diagnoses. The prevalence of H pylori and chronic active gastritis revealed similar age distributions, characterized by an initial rise between the ages 0 and 9 until 30–39 years and a subsequent plateau. In contrast, the prevalence of intestinal metaplasia showed a continuous age-dependent rise. Men and women had similar age distributions. Barrett's metaplasia rose in an age-dependent manner to peak at ages

Discussion

The present study was focused on the histoepidemiology of H pylori as evidenced by pathologic interpretations contained in a large database of gastric and esophageal biopsy specimens. Each diagnostic subgroup was populated by a large number of patients, which increased the statistical power of the analyses. The data were collected in a systematic fashion unbiased towards the aims of the present analysis. Using histologic findings to assess the underlying epidemiology represents a new way to

References (19)

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This article has an accompanying continuing medical education activity on page e12. Learning Objective: Upon completion of this exercise, successful learners will gain a better understanding of the role of Helicobacter pylori in gastroesophageal reflux disease and Barrett's esophagus.

Conflicts of interests The authors disclose the following: Amnon Sonnenberg is supported by a grant from Takeda Pharmaceuticals. Richard H. Lash and Robert M. Genta are employed by Caris Life Sciences, Irving, Texas. Richard H. Lash is an officer and Richard H. Lash and Robert M. Genta are shareholders of Caris Life Sciences. The remaining authors disclose no conflicts.

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