Helicobacter Gastritis
Definition
- Gastric infection by Helicobacter sp.
Alternate / Historic Names
- Campylobacter pylori – old name for H pylori
- Gastrospirillum hominis – old name for H heilmanni
Diagnostic Criteria
- Helicobacter species
- H pylori
- Most common Helicobacter to infect humans by far
- Small curved rods
- Frequently in chain of two, resembling a seagull
- May become coccoid, especially after treatment
- H heilmanni
- Primarily affects domestic cats
- Occasionally infects humans
- Much larger than H pylori
- Clearly visible spirochete structure on light microscopy
- Primarily affects domestic cats
- Others are rarer in western populations
- Primarily localized to surface and gland necks
- Present in mucus or attached to the surface of epithelial cells
- Less frequently attached to parietal and chief cells
- Primarily involves gastric antrum
- May extend to body and cardia
- Loose organisms may wash into duodenum or involve gastric surface metaplasia in duodenum
- Helicobacter is the most common cause of chronic active gastritis
- Intraepithelial neutrophils in surface and gland necks
- Moderate to marked lympho-plasmacytoid infiltrate in superior lamina propria
- Basal lymphoid hyperplasia
- Long-standing cases may produce multifocal atrophic gastritis
- Patchy process
- Destruction of glands
- Lamina propria fibrosis
- Intestinal metaplasia
- May involve all regions of the stomach
- Active inflammation may resolve
- Helicobacter may become difficult to identify
- Non-atrophic areas may revert to normal
- Acute inflammation in surface epithelium and gland necks should prompt close examination and, if necessary, a special stain for Helicobacter
- In untreated cases:
- 70-80% organisms easily found on H&E
- 10-25% require careful search on H&E
- 10-20% require special stain
- Alcian Yellow, Giemsa, Dif-Quik, Steiner and Steiner
- Immunohistochemical stains are easier to interpret
- In untreated cases:
- We perform a special stain if the H&E is negative for the following:
- All pediatric cases with a clinical suspicion of Helicobacter
- All pediatric and adult cases with active chronic gastritis
- All cases with a question of Helicobacter refractory to treatment
- Gastroesophageal junction specimens with acute inflammation of the gastric type mucosa, unless biopsies of the stomach are available for examination
- Gastric biopsies with moderate to severe inactive chronic gastritis only if any of the following are present:
- Lymphocytic duodenitis
- Lymphoid follicles
- History of treated Helicobacter
- Ulcers or neoplasm
- Better to stain adjacent mucosa than the actual neoplasm
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting / last update: 9/9/09 ; 1/19/14
