Abstract
To clarify the relationship between Helicobacter pylori (H. P.) and gastric ulcer, H. P. infection and infiltration of inflammatory cells were investigated in 119 patients with gastric ulcer. Patients were divided into three groups, including 32 patients with intractable ulcers, 62 patients with recurrent ulcers, and 25 patients with initial ulcers. Biopsy specimens were obtained from both the ulcer and the background mucosa in these 119 patients and in 22 control subjects with normal endoscopic findings. The number of H. P. and the number of inflammatory cells were quantitatively determined using both HE staining and immunohistochemical staining for H. P.. H. P. was detected in 100% of the intractable ulcers, which was significantly higher than in the recurrent ulcers (82%), initial ulcers (68%), or normal gastric mucosa (59%). Furthermore, the number of H. P. in the patients with intractable ulcers (2, 240±400/mm2) was significantly higher than in those with recurrent ulcers (1, 850±490/mm2) or the normal controls (1, 150±550/mm2). Recurrent ulcers in both the gastric angle and the antrum showed significantly higher rates of H. P. infection than the gastric mucosa of normal controls. In the background mucosa, the number of neutrophils was significantly higher in patients with intractable or recurrent ulcers than in those with initial ulcers or the normal controls, and neutrophil numbers were significantly larger in patients with H. P.-positive gastric ulcers (232±32/mm2) than in those with H. P.-negative ulcers (44±17/mm2). In addition, a positive correlation was found between the number of H. P. and the number of neutrophils. Follow-up endoscopy revealed that the number of neutrophils at the ulcer margin decreased significantly over time in the patients with initial ulcers, but remained high in the patients with recurrent ulcers. These findings suggest that H. P. infection might result in the persistence and recurrence of gastric ulcer in association with gastric mucosal damage caused by neutrophils.
