A Case of Gastric Low-grade MALT Lymphoma Induced by a Helicobacter heilmannii-like Organism / 대한소화기내시경학회지

Helicobacter heilmannii is a Gram negative, long spiral-shaped organism associated with zoonotic infections acquired from primates including cats and dogs. Infection with H. heilmannii leads to gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. We experienced a 54-year-old man with dyspepsia who was diagnosed with primary gastric MALT lymphoma (stage IE1) associated with a H. heilmannii-like organism. Upper gastrointestinal endoscopy revealed only microvascular dilatation and mucosal granularity without elevated or ulcerative lesions at the stomach angle. He was probably infected by a pet dog. The man was treated with eradication therapy for 2 weeks including lansoprazole, amoxicillin, and clarithromycin. Four weeks after eradication of the H. heilmannii-like organism, follow-up endoscopy and pathological biopsy findings showed complete remission of the gastric MALT lymphoma.

Determinación de Helicobacter spp en cerdos en el departamento de Antioquia, Colombia / Identificação de Helicobacter spp em suínos no departamento de Antioquia, Colômbia / Determination of Helicobacter spp. in swine from Antioquia State, Colombia

Los porcinos desarrollan de manera natural y frecuente úlceras gastroesofágicas (UGE) y se han observado úlceras colonizadas por Helicobacter spp. En los humanos se ha comunicado la asociación de estos microorganismos con gastritis y úlcera gástrica y, de manera análoga, en los suinos se ha relacionado a Helicobacter spp en la producción de lesiones gástricas. Por lo anterior, se realizó esta investigación con los objetivos de determinar la presencia de Helicobacter spp en cerdos del departamento de Antioquia (Colombia) con lesión ulcerosa y preulcerosa de la pars esophagea, y caracterizar histológicamente los diferentes estadios de dicha lesión. Para ello se evaluaron microscópicamente 275 estómagos que presentaron UGE, 15 con erosión y 15 que presentaron la mucosa gástrica intacta. El análisis de los resultados se efectuó mediante estadística descriptiva y se utilizó la prueba de Z para diferenciar proporciones con un nivel de confiabilidad del 95%. Del total de úlceras evaluadas el 74.90% fueron crónicas, el 13.45% subagudas y el 11.63% agudas, de ellas en el 63.63% se determinó la presencia de Helicobacter spp. Este artículo comunica por primera vez en Colombia el hallazgo de colonización natural por Helicobacter spp en porcinos y discute algunos aspectos de la patogenia de la UGE.

Swine as well as human naturally harbor Helicobacter spp. and frequently develop gastroesophagic ulcer (GEU). Nowadays in Colombia there are no reports of natural colonization or infection by Helicobacter spp. in swine. The aim of this study investigation was to verify the presence of Helicobacter spp. in ulcerated and preulcerated lesion in the gastric mucosa of pigs and to typify to the different stages of the lesion. This research was carried out in 275 ulcerated, 15 erosioned and 15 normal stomachs obtained from Medellin abattoir at the State of Antioquia, Colombia. The analysis of the results was made by using descriptive statistic. A Z test was used to establish differences between proportions with a level of confidence of 95%. This paper report for the first time in Colombia the natural colonization of porcine stomach by Helicobacter spp. and discuss some aspects of the pathogenesis of GEU.

Os porcos irá naturalmente desenvolver frequentemente úlceras gastroesofágico (UGE) e som observadas úlceras colonizadas por Helicobacter spp. Nos seres humanos tem sido relatada a associação desses microrganismos com a gastrite ea úlcera gástrica e, de igual modo, no Suína tem sido associada ao Helicobacter spp na produção de lesões gástricas. Pelo exposto esta pesquisa foi realizada com o objetivo de determinar a presença do Helicobacter spp suínos no departamento de Antioquia (Colômbia) com lesão ulcerosa e preulcerosa da pars esophagea, histologia, e caracterizar as diferentes etapas desse prejuízo. É avaliada microscopicamente 275 estômagos apresentando UGE, 15 com a erosão da mucosa gástrica e 15 apresentando mucosa gástrica intacto. A análise dos resultados foi realizada pela estatística descritiva eo teste foi usado para diferenciar Saragoça proporções com um nível de confiabilidade de 95%. Do total foram avaliadas as úlceras crónicas 74.90%, 13.45% e 11.63% subagudas aguda deles em 63.63% ao identificou a presença do Helicobacter spp. Este artigo comunica pela primeira vez na Colômbia a descoberta de colonização natural por Helicobacter spp em suínos e discute alguns aspectos da patogênese da UGE.

A comparative study of H.heilmannii-associated and H. pylori-associated gastritis / 中华消化内镜杂志

Objective To evaluate the clinical manifestations, endoscopic features and the clinical pathological characteristics of H. heilmannii-associated gastritis, and to compare these variables with those of H. pylori-ussociated gastritis. Methods The clinical data, endoscopic findings and pathologic characteristics of 3107 patients, who underwent endoscopy from 2005 to 2007, were retrospectively analyzed. Results Twenty-five cases of H. heilmannii infection were identified, the infection rates of H. heilmannii and H. pylori were 0.80% (25/3107) and 4.12% (1060/3107) respectively. Three cases were mixed infections. Of 25 patients, 20 showed such gastroenterologic symptoms to a greater or less extent as abdominal distending pain,nausea and anorexia, and other 5 cases were asymptomatic. All 25 patients showed chronic gastritis by en-doscopy, including chronic superficial gastritis (7/25, 28% ), erosion ( 3/25, 12% ), chronic atrophic gastritis (4/25, 16%), bile reflux(1/25, 4%), ulcer (1/25, 4%), polyp (1/25, 4%) and duodenal bulbar inflammation (2/25, 8% ). In rapid urease test, 3 cases were hyper-positive, 3 cases positive, 7 ca-ses mild-positive and 12 cases negative. According to histological observation, H. heilmannii scattered or ac-cumulated within the gastric pits, glandular lumen or mucus. The organism was observed in parietal cells with cell damage in one case. Sporadic lymphatic and plasmic infiltration were found in all patients with H.heilmannii infection, infiltration of neutrophils (12/25), gland atrophy and intestinal metaplasia (4/25)and lymphoid follicles (6/25) were also observed. Compared with H. pylori-associated gastritis, H. heilman-nii-associated gastritis showed less inflammation, less helicobacter density, mononuclear cell infiltration and neutrophilic activity ( P < 0.05 ). Conclusion H. heilmanaii mainly induces chronic gastritis, which is less severe than H. pylori-associated gastritis.

Helicobacter heilmannii-associated Gastritis: Clinicopathologic Findings and Comparison with Helicobacter pylori-associated Gastritis

The aims of this study were to evaluate the clinicopathologic features of Helicobacter heilmannii-associated gastritis and to compare H. heilmannii-associated gastritis with H. pylori-associated gastritis. We reviewed 5,985 consecutive gastric biopsy specimens. All cases of chronic gastritis with Helicobacter infection were evaluated with the Updated Sydney System, and the grades of all gastritis variables were compared between H. heilmannii-associated gastritis and H. pylori-associated gastritis groups. There were 10 cases of H. heilmannii-associated gastritis (0.17%) and 3,285 cases of H. pylori-associated gastritis (54.9%). The organisms were superficially located within the mucous layer without adhesion to epithelial cells. Interestingly, in one case many intracytoplasmic H. heilmannii organisms were observed in parietal cells with cell damage. A case of low-grade mucosa-associated lymphoid tissue (MALT) lymphoma concomitant with H. heilmannii infection was detected. Compared to H. pylori-associated gastritis, H. heilmannii-associated gastritis showed less severe neutrophilic activity (p<0.0001), mononuclear cell infiltration (p=0.0029), and endoscopic findings of chronic gastritis devoid of erosion or ulcer (p=0.0309). In conclusion, we present the detailed clinicopathologic findings of H. heilmanniiassociated gastritis compared to H. pylori-associated gastritis. H. heilmannii-associated gastritis is uncommon and milder than H. pylori-associated gastritis, however it may be noteworthy with respect to the development of MALT lymphoma.