Prevalence of Helicobacter pylori infection rate in heterotopic gastric mucosa in histological analysis of duodenal specimens from patients with duodenal ulcer
Hirotsugu Noguchi1,2, Keiichiro Kumamoto1,3, Yoshikazu Harada4, Naoko Sato1, Aya Nawata1, Takashi Tasaki1, Satoshi Kimura1, Shohei Shimajiri1,5 and Toshiyuki Nakayama1
1Department of Pathology, School of Medicine, University of Occupational and Environmental Health, 2Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 3Third Department of Internal Medicine, School of Medicine, 4Department of Dentistry and Oral Surgery and 5Department of Surgical Pathology, University of Occupational and Environmental Health, Japan
Offprint requests to: Hirotsugu Noguchi MD., Ph.D., Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaota, Kagoshima 890-8544, Japan. e-mail: firstname.lastname@example.org
Summary. Heterotopic gastric mucosa in the duodenal bulb is a rare congenital disorder with varied clinical presentations. The mechanism of formation of a duodenal ulcer is failure of balance of the attack factor and the defense factor, which is the same as the mechanism of formation of a gastric ulcer. However, the true etiology of the duodenal ulcer remains unknown. Gastric mucosa can secrete gastric juice which injures itself, but the duodenal mucosa does not contain cells secreting a digestive enzyme. We assume that duodenal ulcers are caused by the presence of heterotopic gastric mucosa that can secrete gastric acid. This study was designed to assess the prevalence and associations of heterotopic gastric mucosa in duodenal ulcers.
The present study included 137 patients who underwent biopsy or resection of duodenal ulcer. We detected gastric foveolar metaplasia due to inflammation from a heterotopic gastric mucosa using immunohisto-chemical staining. Heterotopic gastric mucosa consists of foveolar epithelium (MUC5AC-positive) and fundic gland (H+K+ ATPase-positive parietal cells, pepsinogen I-positive chief cells and MUC6-positive mucous neck cells), whereas gastric metaplasia is composed of foveolar epithelium without fundic glands. These specimens were stained with toluidine blue for detection of Helicobacter pylori infection.
Among the 137 patients with duodenal ulcer, 76 cases (55%) had heterotopic gastric mucosa in the obtained specimens, and Helicobacter pylori was found in 45 cases (59%,45/76) among those with heterotopic gastric mucosa. Our results suggest that heterotopic gastric mucosa was strongly associated with concurrent duodenal ulcer. Histol Histopathol 35, 169-176 (2020)
Key words: Heterotopic gastric mucosa, Gastric metaplasia, Duodenal ulcer, Helicobacter pylori