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#redirect [[Stomach#Helicobacter_gastritis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Helicobacter gastritis - crop -- extremely high mag.jpg
| Width      =
| Caption    = Helicobacter gastritis. [[H&E stain]].
| Micro      = helicobacter organisms, moderate chronic active gastritis (neutrophils esp. at the luminal aspect/intraepithelial, numerous plasma cell clusters)
| Subtypes  = ''[[Helicobacter pylori]]'', ''Helicobacter heilmannii''
| LMDDx      = [[acute gastritis]], [[chronic gastritis]]
| Stains    = [[Diff-Quik]], [[Cresyl violet stain]], [[Warthin-Starry stain]]
| IHC        = Helicobacter IHC
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[stomach]]
| Assdx      = [[MALT lymphoma]], [[gastric carcinoma]], [[intestinal metaplasia of the stomach]], peptic ulcer, [[duodenitis]]
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  = erythema
| Prognosis  = benign
| Other      =
| ClinDDx    = [[normal stomach]]
}}
'''Helicobacter gastritis''', abbreviated '''HG''', is a common form of [[gastritis]] caused by ''Helicobacter'' species. 
 
The most common ''Helicobacter'' implicated is '''''[[Helicobacter pylori]]''''', abbreviated '''[[HP]]'''.
 
==General==
*Several Helicobacter species can cause gastritis:
**''[[Helicobacter pylori]]'' - most common.
**''Helicobacter heilmannii''.
 
Epidemiologic associations - ''Helicobacter'' infections are associated with:<ref>{{Ref PBoD|814}}</ref>
*Gastritis.
*Peptic ulcers.
*Cancer.
**Carcinoma.
**[[MALT lymphoma]].
 
Note:
*Historically, ''Helicobacter'' was grouped with ''Campylobacter''.<ref name=pmid21243784>{{Cite journal  | last1 = Ciortescu | first1 = I. | last2 = Stan | first2 = M. | title = [Helicobacter pylori--friend or foe?]. | journal = Rev Med Chir Soc Med Nat Iasi | volume = 114 | issue = 3 | pages = 619-24 | month =  | year =  | doi =  | PMID = 21243784 }}</ref>
**This is why it is the ''rapid urease test'', sometimes done at endoscopy, is also known as the '' Campylobacter-like organism test'', abbreviated ''CLO test''.
 
==Gross==
*Thickened gastric folds.
*Erythema.
 
==Microscopic==
Features:
*Helicobacter organisms - '''key feature'''.
**''Helicobacter pylori'':
***Usually have v-shape (seagull-like shape). 
****May have a curved shape (comma-like shape) or U-shape.<ref name=pmid21290743>{{Cite journal  | last1 = Mobley | first1 = HLT. | last2 = Mendz | first2 = GL. | last3 = Hazell | first3 = SL. | last4 = Andersen | first4 = LP. | last5 = Wadström | first5 = T. | title = Basic Bacteriology and Culture | journal =  | volume =  | issue =  | pages =  | month =  | year =  | doi =  | PMID = 21290743 | url = http://www.ncbi.nlm.nih.gov/books/NBK2444/}} </ref>
**''Helicobacter heilmannii'':<ref name=pmid16224223 >{{Cite journal  | last1 = Singhal | first1 = AV. | last2 = Sepulveda | first2 = AR. | title = Helicobacter heilmannii gastritis: a case study with review of literature. | journal = Am J Surg Pathol | volume = 29 | issue = 11 | pages = 1537-9 | month = Nov | year = 2005 | doi =  | PMID = 16224223 }}</ref>
***Corkscrew appearance.
*Inflammation - usually ''moderate chronic active''.
**Clusters of (lamina propria) [[plasma cell]]s.
**[[Neutrophil]]s, numerous, classically intraepithelial and superficial.
 
Tips:
#One needs to look at 400x magnification. Even at 400x they are possible to miss.
#*Helicobacter are damn small. They are smaller than the nucleus of the gastric foveollar cell.
#Look for mucus - they preferentially reside there.
#*This is usually close to the opening of the gastric pits.
#Helicobacter are found in groups. When you see several that are the same size and shape you can be sure they are real.
 
Notes:
*Helicobacter can be in antrum and/or body.<ref>{{cite journal |author=Maaroos HI, Kekki M, Villako K, Sipponen P, Tamm A, Sadeniemi L |title=The occurrence and extent of Helicobacter pylori colonization and antral and body gastritis profiles in an Estonian population sample |journal=Scand. J. Gastroenterol. |volume=25 |issue=10 |pages=1010-7 |year=1990 |month=October |pmid=2263873 |doi= |url=}}</ref>
*Helicobacter don't like the intestinal mucosa ''or'' mucosa that has undergone [[intestinal metaplasia]]; you're less likely to find 'em adjacent to it. In general, Helicobacter is uncommon in the context of a case with IM... but common enough that one still ought to look for it.
*May be associated with G-cell hyperplasia.<ref name=pmid8680911>{{Cite journal  | last1 = Kwan | first1 = CP. | last2 = Tytgat | first2 = GN. | title = Antral G-cell hyperplasia: a vanishing disease? | journal = Eur J Gastroenterol Hepatol | volume = 7 | issue = 11 | pages = 1099-1103 | month = Nov | year = 1995 | doi =  | PMID = 8680911 }}</ref>
 
DDx:
*Dirt - material has a variable size.
*Contamination from oropharynx - bacilli straight, not associated with gastric mucosa.
*[[Chronic gastritis]].
*[[Acute gastritis]].
 
===Images===
<gallery>
Image:Immunohistochemical_detection_of_Helicobacter_%281%29_histopatholgy.jpg | H. pylori - IHC. (WC)
Image:Gastritis_helicobacter_-_high_mag.jpg | Gastritis due to HP. (WC)
Image:Gastritis_helicobacter_-_very_high_mag_cropped.jpg | HP visible. (WC)
Image:Stomach_helicobacter_he.JPG | HP gastritis. (WC)
Image:Helicobacter_pylori_in_a_case_of_gastritis.jpg | HP gastritis. (WC)
Image:Helicobacter_pylori,_Gastric_Mucosa,_H%26E.jpg | HP gastritis. (WC)
</gallery>
<gallery>
Image: Helicobacter gastritis -- very high mag.jpg | HP - very high mag. (WC)
Image: Helicobacter gastritis -- extremely high mag.jpg | HP - extremely high mag. (WC)
Image: Helicobacter gastritis - crop -- extremely high mag.jpg | HP - extremely high mag. (WC)
Image: Helicobacter gastritis - ext crop -- extremely high mag.jpg | HP - extremely high mag. (WC)
</gallery>
www:
*[http://commons.wikimedia.org/wiki/Category:Helicobacter_gastritis Set of images - HP gastritis (WC)].
*[http://gut.bmj.com/content/58/12/1669/F2.large.jpg Helicobacter heilmannii (bmj.com)].<ref>URL: [http://gut.bmj.com/content/58/12/1669.extract http://gut.bmj.com/content/58/12/1669.extract]. Accessed on: 2 March 2012.</ref>
====Helicobacter heilmannii====
<gallery>
File:Helicobacter-heilmannii.JPG | HH. (WC/Patho)
File:Helicobacter-heilmannii_2.JPG | HH. (WC/Patho)
File:Helicobacter-heilmannii_3.JPG | HH. (WC/Patho)
</gallery>
 
==Stains==
*[[Cresyl violet stain]] - background and organisms blue.
*[[Warthin-Starry stain]] - background yellow, organisms black.
 
==IHC==
*Helicobacter pylori IHC stain +ve.
 
Note:
*Reportly also stains ''Helicobacter heilmannii''.<ref name=pmid16224223 >{{Cite journal  | last1 = Singhal | first1 = AV. | last2 = Sepulveda | first2 = AR. | title = Helicobacter heilmannii gastritis: a case study with review of literature. | journal = Am J Surg Pathol | volume = 29 | issue = 11 | pages = 1537-9 | month = Nov | year = 2005 | doi =  | PMID = 16224223 }}</ref>
 
==Sign out==
===Antrum===
<pre>
Stomach, Antrum, Biopsy:
- Antral-type gastric mucosa with abundant HELICOBACTER-LIKE ORGANISMS
  and moderate chronic active inflammation.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
 
===Body===
<pre>
Stomach, Body, Biopsy:
- Body-type gastric mucosa with abundant HELICOBACTER-LIKE ORGANISMS
  and moderate chronic active inflammation.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
 
===IELs in duodenum===
<pre>
A. Duodenum, Biopsy:
- Small bowel mucosa with increased intraepithelial lymphocytes, villous
  architecture and crypt architecture within normal limits, see comment.
- NEGATIVE for acute duodenitis.
- NEGATIVE for dysplasia.
 
B. Stomach, Biopsy:
- Body-type gastric mucosa with moderate chronic active inflammation
  and abundant HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
 
COMMENT:
There are approximately 45 lymphocytes/100 enterocytes. Increased intraepithelial lymphocytes (IELs) is a nonspecific finding. IELs are seen in celiac disease and inflammatory bowel disease; however, may be explained by the Helicobacter-like organisms found in the stomach. Clinical correlation is suggested.
</pre>
 
=====Alternate comment=====
<pre>
Comment:
Focally, there are approximately 50 lymphocytes/100 enterocytes. Increased intraepithelial
lymphocytes is a nonspecific finding that may be seen in a number of conditions, including
infections (e.g. Helicobacter gastritis), and autoimmune disorders (e.g. Crohn's disease, celiac disease). In this case, it may be explained by the Helicobacter-like organisms found in the stomach. Clinical correlation is suggested.
</pre>
 
====Block letters====
<pre>
STOMACH, BIOPSY:
- BODY-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
===Antrum===
<pre>
Stomach, Antrum, Biopsy:
    - Antral-type gastric mucosa with abundant HELICOBACTER-LIKE ORGANISMS,
      and moderate chronic active inflammation.
    - NEGATIVE for intestinal metaplasia.
    - NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
 
=====Alternate=====
<pre>
Stomach, Biopsy:
- Antral-type gastric mucosa with moderate chronic active inflammation.
- Abundant Helicobacter-like organisms present.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
 
=====Block letters=====
<pre>
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====IM present====
<pre>
Stomach, Biopsy:
- Antral-type gastric mucosa with:
-- Focal intestinal metaplasia.
-- Abundant Helicobacter-like organisms.
-- Moderate chronic active gastritis.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
 
======Block letters======
<pre>
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH:
-- FOCAL INTESTINAL METAPLASIA.
-- ABUNDANT HELICOBACTER-LIKE ORGANISMS.
-- MODERATE CHRONIC ACTIVE INFLAMMATION.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
====H. heilmannii====
<pre>
Stomach, Biopsy:
- Antral-type gastric mucosa with moderate chronic active inflammation.
- Abundant Helicobacter-like organisms present.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
 
Comment:
The Helicobacter-like organisms have an appearance similar to crinkle cut French fries; this suggests the organisms are H. heilmannii.
</pre>
 
===Micro===
The sections show antral-type gastric mucosa with abundant lamina propria plasma cells and
focal intraepithelial neutrophils. Cocci and bacilli are present.  Some of the bacilli
are Helicobactor-like. The epithelium matures normally to the surface.  No goblet cells
are identified.
 
==See also==
*[[Stomach]].
*[[Chronic gastritis]].
*[[Helicobacter duodenitis]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Stomach]]
[[Category:Gastrointestinal pathology]]
Michael
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