Correlation between the degree of duodenal bulbar deformity and the density of Helicobacter pylori infection in patients with active duodenal ulcers.

BACKGROUND: Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer disease. This prospective study was carried out to investigate the relationship between the degree of bulbar deformity and the density of Helicobacter pylori infection in patients with duodenal ulcer. METHODS: Patients with endoscopically proven active duodenal ulcers and a positive diagnosis of H. pylori infection were enrolled. Duodenal ulcers were divided into three types according to the degree of deformity of the bulb: type I, normal bulb; type II, mildly deformed; type III, markedly deformed. In each case, we evaluated the H. pylori density histologically. The density was graded according to the Sydney system (normal, mild, moderate, and marked). RESULTS: A total of 95 duodenal ulcer patients were studied, including 25 with type I, 40 with type II, and 30 with type III duodenal ulcers. H. pylori density was correlated with deformity of the duodenal bulb: 16/25 (64%) patients with a type I ulcer had mild infection, 19/40 (47.5%) patients with a type II ulcer had moderate infection, and 15/30 (50%) patients with a type III ulcer had marked infection. CONCLUSION: Patients with active type II or III duodenal ulcers had greater densities of H. pylori than did those with type I ulcers. A tendency for higher H. pylori density was seen as the degree of deformity of the duodenal bulb increased.