{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:12:42Z","timestamp":1790860362195,"version":"4.1.0"},"reference-count":29,"publisher":"BMJ","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Clin Pathol"],"published-print":{"date-parts":[[1990,12]]},"abstract":"<jats:p>Duodenal biopsy specimens from 471 adults and 47 children were examined to determine the prevalence and distribution of gastric epithelium in the duodenal bulb in relation to age, gender, gastroduodenal inflammation, smoking, alcohol and consumption of nonsteroidal anti-inflammatory drugs (NSAID). Gastric metaplasia was present in the anterior wall duodenal biopsy specimen in 31%, was significantly less common in patients under 17 than in adults, and was more common in males than females. In sixty two adults who underwent multiple radial duodenal biopsy gastric metaplasia was randomly distributed around the duodenal circumference; sixty three per cent of the patients with gastric metaplasia found on multiple biopsy were detected by just the anterior biopsy. Gastric metaplasia was not obviously associated with alcohol, cigarette, or NSAID consumption. While the presence of gastric metaplasia was associated with adulthood, male sex, and low fasting gastric juice pH, its extent was associated with active duodenitis and Helicobacter-associated gastritis. On logistic regression, gastric metaplasia in the duodenum and gastric Helicobacter pylori were independent predictors of active duodenitis, but were not significantly associated with inactive duodenal inflammation. H pylori was observed in duodenal biopsy specimens from 32 patients, all with active duodenitis; bacteria were present only on foci of gastric metaplasia, and were more likely to be seen when the metaplasia was extensive. It is proposed that inflammatory injury to the duodenal mucosa by H pylori may stimulate the development of further gastric metaplasia, and that the area of duodenum susceptible to colonisation with H pylori may therefore increase progressively until mucosal integrity is compromised and ulceration supervenes.<\/jats:p>","DOI":"10.1136\/jcp.43.12.981","type":"journal-article","created":{"date-parts":[[2007,6,9]],"date-time":"2007-06-09T00:50:46Z","timestamp":1181350246000},"page":"981-986","source":"Crossref","is-referenced-by-count":161,"title":["Gastric epithelium in the duodenum: its association with Helicobacter pylori and inflammation."],"prefix":"10.1136","volume":"43","author":[{"given":"J I","family":"Wyatt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B J","family":"Rathbone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G M","family":"Sobala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Shallcross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R V","family":"Heatley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A T","family":"Axon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M F","family":"Dixon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1990,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/0016-5085(87)91028-6","article-title":"Gastric Campylobacter-like organisms, gastritis, and peptic ulcer disease","volume":"93","author":"Blaser, M.J.","year":"1987","unstructured":"Blaser MJ. 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Lancet 1984;ii:100.","journal-title":"Lancet"},{"key":"ref_6","first-page":"118","article-title":"Campylobacter pylori and development of duodenal ulcer","volume":"i:","author":"Wyatt, J.I.; Rathbone, B.J.; Dixon, M.F.","year":"1988","unstructured":"Wyatt JI, Rathbone BJ, Dixon MF, et al. Campylobacter pylori and development of duodenal ulcer. Lancet 1988;i: 118-9.","journal-title":"Lancet"},{"key":"ref_7","first-page":"12","article-title":"Peptic ulcer","volume-title":"textbook of medicine","author":"Misiewicz, J.J.; Pounder, R.E.","year":"1987","unstructured":"Misiewicz JJ, Pounder RE. Peptic ulcer. In: Weatherall DJ, Ledingham JGG, Warrell DA, eds. Oxford textbook of medicine. 2nd ed. Oxford: Oxford University Press, 1987: 12-64.","edition":"2nd ed"},{"key":"ref_8","article-title":"Mucosal biopsy of thegastrointestinal tract","author":"Whitehead, R.","year":"1984","unstructured":"Whitehead R. Mucosal biopsy of thegastrointestinal tract. 3rd ed. Philadelphia: WB Saunders, 1984.","edition":"3rd ed"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1136\/jcp.39.11.1279-a","article-title":"Simplified techniques for identifying gastric Campylobacter pyloridis on tissue sections","volume":"39","author":"Grey, S.F.; Wyatt, J.I.; Rathbone, B.J.","year":"1986","unstructured":"Grey SF, Wyatt JI, Rathbone BJ. Simplified techniques for identifying gastric Campylobacter pyloridis on tissue sections. J Clin Pathol 1986;39:1279-80.","journal-title":"J Clin Pathol"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/j.1365-2559.1983.tb02213.x","article-title":"The endoscopically abnormal duodenum in patients with dyspepsia: biopsy findings in 60 cases","volume":"7","author":"Shousha, S.; Spiller, R.C.; Parkins, R.A.","year":"1983","unstructured":"Shousha S, Spiller RC, Parkins RA. The endoscopically abnormal duodenum in patients with dyspepsia: biopsy findings in 60 cases. Histopathology 1983;7:23-34.","journal-title":"Histopathology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/path.1711530204","article-title":"Variations in the morphology of villous epithelial cells within 8 mm of untreated duodenal ulcers","volume":"53","author":"Gregory, M.A.; Spitaels, J.M.","year":"1987","unstructured":"Gregory MA, Spitaels JM. Variations in the morphology of villous epithelial cells within 8 mm of untreated duodenal ulcers. J Pathol 1987;53:109-19.","journal-title":"J Pathol"},{"key":"ref_12","first-page":"142","article-title":"Possible pathogenetic pathways of Campylobacter pylori in gastro-duodenal disease","volume":"23","author":"Rathbone, B.J.; Wyatt, J.I.; Heatley, R.V.","year":"1987","unstructured":"Rathbone BJ, Wyatt JI, Heatley RV. Possible pathogenetic pathways of Campylobacter pylori in gastro-duodenal disease. Scand J Gastroenterol 1987;23(suppl 142):40-3.","journal-title":"Scand J Gastroenterol"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1136\/jcp.38.10.1119","article-title":"Defining duodenitis; quantitative histological study of mucosal responses and their correlations","volume":"38","author":"true","year":"1985","unstructured":"Jenkins D, Goodall A, Gillett FR, et al. Defining duodenitis; quantitative histological study of mucosal responses and their correlations. J Clin Pathol 1985;38: 1119-26.","journal-title":"J Clin Pathol"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1136\/gut.22.4.277","article-title":"Mucosal cell proliferation in duodenal ulcer and duodenitis","volume":"22","author":"Bransom, C.J.; Boxer, M.E.; Palmer, K.R.","year":"1981","unstructured":"Bransom CJ, Boxer ME, Palmer KR, et al. Mucosal cell proliferation in duodenal ulcer and duodenitis. 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Endoscopy 1982;14:193-5.","journal-title":"Endoscopy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1016\/S0140-6736(88)90929-4","article-title":"Prospective double blind trial after eradication of Campylobacter pylori","volume":"ii:","author":"Marshall, B.J.; Warren, JR, Blincow; E.D.","year":"1988","unstructured":"Marshall BJ, Warren JR, Blincow ED, et al. Prospective double blind trial after eradication of Campylobacter pylori. Lancet 1988;ii:1437-41.","journal-title":"Lancet"},{"key":"ref_20","first-page":"540","article-title":"Gastric epithelium in the duodenum of a patient with gastric hyperacidity. 2nd World Congress of Gastroenterology","volume":"H:","author":"James, A.H.","year":"1962","unstructured":"James AH. 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Gastroenterol 1975;69:903-10.","journal-title":"Gastroenterol"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1136\/gut.5.5.454","article-title":"Experimental production of gastric epithelium in the duodenum","volume":"5","author":"Rhodes, J.","year":"1964","unstructured":"Rhodes J. Experimental production of gastric epithelium in the duodenum. Gut 1964;5:454-8.","journal-title":"Gut"},{"issue":"49","key":"ref_24","first-page":"105","article-title":"The reactions ofthe intestine ofthe pig to gastric juice","volume":"1939","author":"Florey, H.W.; Jennings, M.A.; Jennings, D.A.","unstructured":"Florey HW, Jennings MA, Jennings DA, et al. The reactions ofthe intestine ofthe pig to gastric juice. JPathol Bacteriol 1939;49: 105-23.","journal-title":"JPathol Bacteriol"},{"key":"ref_25","article-title":"Relationship of Campylobacter pylori to duodenal ulcer disease","volume-title":"pylori in gastritis and peptic ulcer disease","author":"Wyatt, J.I.","year":"1989","unstructured":"Wyatt JI. Relationship of Campylobacter pylori to duodenal ulcer disease. In: Blaser MJ, ed. Campylobacter pylori in gastritis and peptic ulcer disease. New York: Igaku-Shoin, 1989."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1136\/gut.30.3.311","article-title":"Enhancement by tetragastrin of experimental induction of gastric epithelium in the duodenum","volume":"30","author":"Tatsuta, M.; Ishii, H.; Yamamura, H.; Yamamoto, R.; Taniguchi, H.","year":"1989","unstructured":"Tatsuta M, Ishii H, Yamamura H, Yamamoto R, Taniguchi H. Enhancement by tetragastrin of experimental induction of gastric epithelium in the duodenum. Gut 1989;30: 311-5.","journal-title":"Gut"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000198441","article-title":"Pathological and histomorphometric study ofthe effects ofalcohol on the human duodenum","volume":"20","author":"Lev, R.; Thomas, E.; Paul, F.F.","year":"1980","unstructured":"Lev R, Thomas E, Paul FF. Pathological and histomorphometric study ofthe effects ofalcohol on the human duodenum. Digestion 1980;20:207-13.","journal-title":"Digestion"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/BF01318515","article-title":"A study of incidence and relationship of intestinal metaplasia on gastric antrum and gastric metaplasia of duodenum in patients with non-ulcer dyspepsia","volume":"29","author":"Shousha, S.; Barrison, I.G.; El-Sayeed, W.","year":"1984","unstructured":"Shousha S, Barrison IG, El-Sayeed W, et al. A study of incidence and relationship of intestinal metaplasia on gastric antrum and gastric metaplasia of duodenum in patients with non-ulcer dyspepsia. Dig Dis Sci 1984;29: 311-6.","journal-title":"Dig Dis Sci"},{"key":"ref_29","first-page":"271","article-title":"Duodenal bulb biopsy findings for patients with non-ulcer dyspepsia with or without Campylobacter pylori gastritis","volume":"3","author":"Frierson, H.F.; Caldwell, S.H.; Marshall, B.J.","year":"1990","unstructured":"Frierson HF, Caldwell SH, Marshall BJ. Duodenal bulb biopsy findings for patients with non-ulcer dyspepsia with or without Campylobacter pylori gastritis. Modern Pathol 1990;3:271-7.","journal-title":"Modern Pathol"}],"container-title":["Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jcp.43.12.981","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T03:38:54Z","timestamp":1765597134000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcp.bmj.com\/lookup\/doi\/10.1136\/jcp.43.12.981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1990,12]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[1990,12,1]]},"published-print":{"date-parts":[[1990,12]]}},"alternative-id":["10.1136\/jcp.43.12.981"],"URL":"https:\/\/doi.org\/10.1136\/jcp.43.12.981","relation":{},"ISSN":["0021-9746","1472-4146"],"issn-type":[{"value":"0021-9746","type":"print"},{"value":"1472-4146","type":"electronic"}],"subject":[],"published":{"date-parts":[[1990,12]]}}}