Intestinal Metaplasia of the Gastric Mucosa: A Gross and Microscopic Study of Its Distribution in Various Disease States2

Abstract

Gross stomach specimens may be stained to demonstrate areas of alkaline phosphatase activity. Since this is found only in parts of the mucosa showing intestinal metaplasia, it provides a new perspective for assessing this change in the stomach. The alteration was most frequent and most intense on the lesser curvature at the junction of the pylorus and corpus. The change at this site was frequently associated with a band of metaplasia on both anterior and posterior walls at the junction of the pylorus and corpus. Although metaplasia was more frequently associated with cancer than gastric ulcer, it had the same distribution when associated with either of these conditions. The most frequent site of gastric ulcer was more closely correlated with sites of maximal metaplasia than was carcinoma. Even when cancer and metaplasia coexisted, the sites of these changes did not always coincide. Microscopic analysis of the intestinal metaplasia indicated it may begin in the neck region of glands unaffected by gross injury or microscopic evidence of inflammation.