Difference between revisions of "Helicobacter gastritis"

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#redirect [[Stomach#Helicobacter_gastritis]]
'''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]].
 
==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.
 
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]].
 
===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)
</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>
 
==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==
===Body===
<pre>
STOMACH, BIOPSY:
- BODY-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
===Antrum===
<pre>
STOMACH, BIOPSY:
- ANTRAL-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</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]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 14:22, 23 July 2013

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:

Epidemiologic associations - Helicobacter infections are associated with:[1]

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.[2]
    • Helicobacter heilmannii:[3]
      • Corkscrew appearance.
  • Inflammation - usually moderate chronic active.

Tips:

  1. 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.
  2. Look for mucus - they preferentially reside there.
    • This is usually close to the opening of the gastric pits.
  3. 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.[4]
  • 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.[5]

DDx:

  • Dirt - material has a variable size.
  • Contamination from oropharynx - bacilli straight, not associated with gastric mucosa.
  • Chronic gastritis.

Images

  • H. pylori - IHC. (WC)

  • Gastritis due to HP. (WC)

  • HP visible. (WC)

www:

Stains

IHC

  • Helicobacter pylori IHC stain +ve.

Note:

  • Reportly also stains Helicobacter heilmannii.[3]

Sign out

Body

STOMACH, BIOPSY:
- BODY-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Antrum

STOMACH, BIOPSY:
- ANTRAL-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

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

References

  1. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 814. ISBN 0-7216-0187-1.
  2. ↑ Mobley, HLT.; Mendz, GL.; Hazell, SL.; Andersen, LP.; Wadström, T.. Basic Bacteriology and Culture. PMID 21290743. http://www.ncbi.nlm.nih.gov/books/NBK2444/.
  3. ↑ 3.0 3.1 Singhal, AV.; Sepulveda, AR. (Nov 2005). "Helicobacter heilmannii gastritis: a case study with review of literature.". Am J Surg Pathol 29 (11): 1537-9. PMID 16224223.
  4. ↑ Maaroos HI, Kekki M, Villako K, Sipponen P, Tamm A, Sadeniemi L (October 1990). "The occurrence and extent of Helicobacter pylori colonization and antral and body gastritis profiles in an Estonian population sample". Scand. J. Gastroenterol. 25 (10): 1010-7. PMID 2263873.
  5. ↑ Kwan, CP.; Tytgat, GN. (Nov 1995). "Antral G-cell hyperplasia: a vanishing disease?". Eur J Gastroenterol Hepatol 7 (11): 1099-1103. PMID 8680911.
  6. ↑ URL: http://gut.bmj.com/content/58/12/1669.extract. Accessed on: 2 March 2012.
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