Until 10 years ago, it was believed that there is a continuous progression from surface gastritis to atrophic gastritis (over a 10-year duration) to metaplastic gastritis (with a further 10-year duration). However, the discovery of H. pylori has completely changed this notion. Kuipers et al.10 performed an interesting prospective study and showed that atrophic gastritis with intestinal metaplasia (Figure 12.4) appeared in only 4% of cases in an H. pylori-negative group after 10 to 13 years of observation but in 28% in H. pylori-

positive cases.

Studies on the association of H. pylori with gastric cancer start with a report in 1991, which described the higher serum titer for H. pylori in patients who developed gastric adenocarcinoma in a prospective study.31'32 There are basically two kinds of gastric adenocarcinoma: well-differentiated (intestinal type) and poorly differentiated (diffuse type). In a Japanese study that focused on early gastric cancer, the odds for serum positivity were higher in well-differentiated adenocarcinoma than in poorly differentiated adenocarcinoma.33

FIGURE 12.4 Chronic gastritis with intestinal metaplasia (hematoxylin and eosin staining). Note the ballooned

cells filled with mucin. These cells are quite similar to intestinal cells.

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