Helicobacter pylori infection, not gastroesophageal reflux, is the major cause of inflammation and intestinal metaplasia of gastric cardiac mucosa.

Goldblum JR, Richter JE, Vaezi M, Falk GW, Rice TW, Peek RM
Am J Gastroenterol. 2002 97 (2): 302-11

PMID: 11866266 · DOI:10.1111/j.1572-0241.2002.05462.x

OBJECTIVE - The etiology of inflammation below the normal Z-line is an area of intense debate. Some suggest this is the earliest change of chronic gastroesophageal reflux disease (GERD), whereas others indict Helicobacter pylori (H. pylori) as the main cause. The aim of this study was to evaluate the relationship among inflammation of gastric cardiac mucosa (carditis), H. pylori infection, and intestinal metaplasia in patients with GERD and Barrett's esophagus compared with age-matched controls.

METHODS - Patients with GERD and Barrett's esophagus were compared with controls undergoing endoscopy for a variety of other conditions. Endoscopic biopsy specimens from the gastric cardia (obtained on retroflexed view), fundus, and antrum were evaluated for inflammation, H. pylori infection, and intestinal metaplasia.

RESULTS - The prevalence of H. pylori infection did not significantly differ among the study populations: controls (42%), GERD (33%), and Barrett's esophagus (27%) (p = 0.20). However, the prevalence of carditis significantly decreased from the control group (30%) to those with GERD (23%) and Barrett's esophagus (11%) (p = 0.03). Overall, 42 of 51 (82%) patients with carditis had H. pylori; all had pangastritis. The prevalence of cardia intestinal metaplasia also significantly decreased from the control group (15%) to those with GERD (4%) and Barrett's esophagus (0%) (p = 0.003). Of 13 patients with cardia intestinal metaplasia, 12 had carditis, 10 had H. pylori infection, and seven had intestinal metaplasia elsewhere in the stomach.

CONCLUSIONS - Inflammation of gastric cardiac mucosa decreases in prevalence from controls to patients with GERD and Barrett's esophagus and correlates strongly with H. pylori infection. Cardia intestinal metaplasia is associated with H. pylori-related cardiac inflammation and intestinal metaplasia elsewhere in the stomach.

MeSH Terms (27)

Adult Aged Aged, 80 and over Age Distribution Analysis of Variance Barrett Esophagus Biopsy, Needle Cardia Case-Control Studies Cohort Studies Esophagoscopy Female Gastric Mucosa Gastritis Gastroesophageal Reflux Gastroscopy Helicobacter Infections Helicobacter pylori Humans Intestinal Mucosa Male Middle Aged Prevalence Prognosis Risk Assessment Risk Factors Sex Distribution

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