Journal of zyxwvutsrqponmlk Gastroenterology and Hepatology zyxwvutsr (1995) zyxwvutsr 10,331-333 zyxwvuts ALIMENTARY TRACT AND PANCREAS Barrett’s oesophagus and zyxw Helicobacter pylori ZAIGHAM ABBAS, AKBAR S. HUSSAINY,‘ FARHAT IBRAHIM, S. M. WASIM JAFRI, HIZBULLAH SHAIKH’ AND A. HALEEM KHAN Departments of Medicine and ‘Pathology, The Aga Khan UniversityHospital, Karachi Pakistan Abstract In order to demonstratethe presence of Helicobucter pylon’in the metaplastic epithelium of Barrett’s oesophagus and to evaluate its possible association with this entity, we examined zyxw 29 cases of Barrett’s oesophagus where concomitant antral biopsies were also available. These cases were compared with an equal number of age and sex matched controls of uncomplicated reflux oesophagitis. H. pylori was present in 11 of 29 cases of Barrett’s oesophagus (38%). No increase in the frequency of H. pylon’ antral gasmtis was found in patients of Barrett’s oesophagus compared to the control group of uncomplicated reflux oesophagitis. The positivity of Barrett’s oesophagus for H. pylon’ correlated with the presence of H. pylm’ antral gasmtis (P zyxwvutsrqp < 0.05), although in two cases of H. pylon*-positive Barrett’s oesophagus antral biopsies were negative for H. pylori. No difference was found in the severity of inflammatory and dysplastic changes of H. pylori- positive and H. pylmi-negative Barrett’s oesophagus. Presence of H. pylari does not seem to alter the natural history of Barrett’s oesophagus. Key words: Barrett’s oesophagus, HeZicobacter j~jd~ti, reflux oesophagitis. INTRODUCTION Barrett’s oesophagus’ is a pathological condition charac- terized by metaplastic replacement of normal squamous epithelium of distal oesophagus by columnar epithelium of a heterogeneous variety? It is a zyxwvut recognized complication of gastrooesophageal reflux disease3 and has a malignant potential.4,’ Helicobucter pylon‘ is frequently found splayed along the gastric mucosa and its infection is strongly associated with antral (type B) ga~mtis.~~~ The organism also infects the areas of gasmc metaplasia of duodenum.*,9 We examined cases of Barrett’s oesophagus to demonstrate the presence of H. pylon’ in zyxwvuts this metaplastic epithelium and to evaluate its possible implications. METHODS Between January 1991 and June 1993, 1072 oesophageal biopsies were taken from patients presented to the Adult Gastroenterology Service of The Aga Khan University Medical Centre. Diagnosis of Barren’s oesophagus was made in 40 cases. This analysis was carried out on 29 cases which Willed the following criterk (i) the endoscopic and biopsy evidence of htt’s oesophagus; (ii) con- mmitant antral biopsy specimens were available; and (iii) these patients had not received any antihelicobacter treat- ment. Endoscopy records were reviewed to confirm the presence of columnar epithelium in the tubular oesophagus and to exclude hiatus hernia. Barrett’s oesophagus was defined endompically as presence of velvety red mucosa in the distal oesophagus extending above the lower oesophageal sphincter either circumferentially for 3 cm or as tongues or islands. Oesophagitiswas defined as presence of hyperaemia, erosions or ulcerations. Evidence of any antd hyperaemia was recorded. At least three biopsies were obtained from the Barrett’s oesophagus and two from antrum. Biopsy sections were stained with haematoxylin and eosin (H&E) for routine histology and modified Giemsa’s stain for the detection of H. pylon.. Specimens were reviewed by two experienced histopatholgists. The sensitivity of diagnosis of H. pylon. by these histopathologists was evaluated. It was found to be comparable to the rapid urease test (89 ‘us 84%). The Barrett’s oesophagus was categorized into three epithelial types: (1) F u n d epithelium: gastric fundus like epithelium with pits, mucous glands, parietal and chief cells. (2) Junctionalepithelium: similar to that of cardia with pits and mucous glands but no parietal or chief cells. (3) Specialized columnar epithelium: similar to that of s d bowel with villiform surface, mucous glands and intestinal type of goblet cells. One or more types could be recognized in a given specimen. Correspondence: Dr Zaigham Abbas, The Aga Khan University Hospital, Karachi, Pakistan. Accepted for publication 5 August 1994.