Lack of association between Helicobacter pylori and gastric atrophy or intestinal metaplasia in elderly patients

Helicobacter pylori (Hp) is associated with gastritis and peptic ulcers. It may also induce gastric atrophy (GA) and intestinal metaplasia (IM), and these changes may be the precursors of gastric carcinoma. The aim of this study was to determine if GA or IM is associated with Hp infection in elderly patients. Consecutive patients admitted for gastroscopy were recruited. Multiple biopsies were taken for histology and rapid urease (CLO) tests along with IgG enzyme-linked immunosorbent assay antibodies and C-13-urea breath tests. Statistical analysis was by chi(2) tests. 114 patients were recruited, the average age was 78.9 +/- 5.4 years. Histology was available on 105 patients, 80 (76.2%) had gastritis, and 61/80 (76.25%) had evidence of definite current Hp infection. Seven patients had reflux gastritis, and these were excluded from the analysis described below. 20 patients had GA and 24 IM. The relationship between Hp and GA or IM was investigated by dividing patients into four groups: Group 1 patients (n = 57) were taken to be definitely currently infected (GA 7 patients, IM 11, both 1). Group 2 patients (n = 18) had old infection (GA 2, IM 4, both 3). Group 3 patients (n = 16) have never been infected previously (GA1, IM 1, both 3). Group 4 patients (n = 4) had a poor immunological response to Hp (GA 1, IM I, both 0). There were no significant differences in the numbers of patients with GA or IM in any group as compared with any other, with the exception of less patients with histological evidence of combined GA and IM among patients with definite current infection as compared with those with either previous infection (p = 0.04) or 'never' infection (p = 0.03). We conclude that the mucosal changes of GA or IM are not consistently associated with Hp infection in the elderly.