Helicobacter pylori and intestinal metaplasia: comparison between British and Yemeni patients

There have been suggestions linking gastric carcinoma with Helicobacter pylori on the one hand and type III intestinal metaplasia on the other hand. This study was aimed at investigating the relationship between intestinal metaplasia and its subtypes, and the presence or absence of H. pylori in gastric biopsies from two geographically different patient populations, one with a much higher prevalence of H. pylori than the other. Antral biopsies from 179 British and 123 Yemeni patients with dyspepsia were examined. Sections stained with hematoxylin and eosin, Alcian blue/periodic acid-Schiff, high iron diamine/Alcian blue, and Warthin-Starry stains were used to assess the presence or absence of inflammation, H. pylori, and intestinal metaplasia with its three subtypes. Although Yemeni patients had a significantly higher prevalence of H. pylori than British patients (113/123. 92% vs. 83/179, 46% respectively; p < 0.001), Yemeni patients had a significantly lower prevalence of all types of intestinal metaplasia (23/123, 19% vs. 60/179, 34%; p < 0.001), as well as type III metaplasia (4/123, 3% vs. 39/179, 22%, p < 0.001). These trends persisted when only patients above the age of 40 yr were considered. However, in British patients, intestinal metaplasia was more commonly seen in those with H. pylori than in those without (36/83, 43%, and 24/96, 25%, respectively, p < 0.01), although the prevalence of type III metaplasia was not significantly different in the two groups (23/83, 28% vs. 16/96, 17%, respectively). The contrasting findings in the two patient populations suggest the presence of other factors, possibly genetic, which control the development of intestinal metaplasia and possibly gastric carcinoma in H. pylori-positive patients.