Endoscopic biopsies from the duodenal cap and prepyloric areas of 25 patients have been examined with the scanning electron microscope. Eleven patients had duodenal ulceration. Bacteria are related only to the surface of gastric type epithelial cells whether these cells are located at areas of gastric metaplasia in the duodenal bulb or in the pre-pyloric region of the stomach. The bacteria are not associated with the surface of intestinal type epithelial cells. The bacteria are absent from the biopsies of those patients with a normal stomach and duodenum. Of those patients with duodenal ulceration, 73% have bacteria related to the epithelial surface. The bacteria are of two morphological types - a kidney shaped bacillus and an S-shaped bacillus.
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