Histopathologic and clinical data strongly suggest a causal relation between Helicobacter pylori
infection and
gastritis,
peptic ulcer disease, or both. However, little has been written about the potential association between H. pylori
infection and Brunner's gland
adenoma. Therefore, we carried out a prospective study to determine the presence of H. pylori
infection among patients with Brunner's gland
adenoma. From November 1996 till October 1999, 19100 patients who had undergone upper gastrointestinal endoscopy at two clinical centers in Zagreb, Croatia, were candidates for participation in the study. Brunner's gland
adenoma was diagnosed on the basis of histologic samples taken from the
polyp (four patients) or after the entire
polyp was made available upon endoscopic removal (three patients). When all endoscopic examinations had been performed, biopsy samples were taken from the antrum and body of the stomach, so that
gastritis could be classified and H. pylori determined by histology. Biopsy samples were also taken from the duodenal bulb to verify
duodenitis. Two other samples were taken from the antrum for rapid
urease test. The patients were considered positive for H. pylori when both histology and rapid
urease test were positive. Brunner's gland
adenoma was diagnosed in seven patients (five women and two men; median age, 49 yrs). Five (71%) patients with diagnosed Brunner's gland
adenoma had concurrent H. pylori
infection.
Duodenitis associated with gastric
metaplasia was observed in six patients. Complete eradication of H. pylori was achieved in only two patients. Symptoms disappeared or markedly diminished in all patients with significant improvement during
therapy or immediately upon endoscopic removal of the
polyp. Although limited by a very small number of patients, our results suggest that concurrent H. pylori
infection is very common in patients with Brunner's gland
adenoma. However, the role of H. pylori
infection in the pathogenesis and development of Brunner's gland
hyperplasia remains unclear.