Helicobacter pylori infection and age on the development of intestinal metaplasia--a multiple logistic regression analysis.

Background/aims: Both intestinal metaplasia (IM) and Helicobacter pylori (H. pylori) infection have been linked to gastric carcinogenesis in an age-dependent manner. However, their relationship remains ill defined, especially with respect to age.
Methodology: Three hundred and two asymptomatic subjects (167 males and 135 females; mean age 44.3+/-11.1 years) underwent complete endoscopic examination and biopsy at the antrum and the corpus. H. pylori infection was diagnosed according to histopathology and serology, while IM was determined by histopathology.
Results: Eighty-four patients (27.8%) had IM, while 185 patients (61.3%) were seropositive to H. pylori. The frequency of IM was higher in patients with gastric ulcer (9/14, 64.3%) than in those with minimal change (68/229, 29.7%) or duodenal ulcer (7/59, 11.9%), both p<0.01. Patients with IM had a higher mean age (49.5+/-14.1 vs. 42.3+/-9.0, p<0.01) and a higher H. pylori prevalence than those without IM (61/84, 72.6% vs. 124/218, 56.9%, p<0.01). The concordance rate of H. pylori infection between histopathologic and serologic diagnosis was lower in patients with IM (67/84, 79.8%) than those without (196/218, 89.9%, p<0.05). Using logistic regression analyses, the development of IM was noted to be independently related to both H. pylori infection (odds ratio=1.97, 95% confidence interval: 1.1(3.53)) and age (odds ratio = 1.93, 95% confidence interval: 1.51(2.47)).
Conclusions: These data suggest that age and H. pylori infection are independent risk factors for the development of IM. Furthermore, H. pylori infection may have been underestimated in patients with IM because of the use of a single method of detection.