Gastritis –Not Due to Helicobacter pylori

A gastroenterologist identifying gastritis or an ulcer due to Helicobacter pylori is akin to an emergency room doctor treating a nursemaid’s elbow.  In both cases, identifying the cause allows for effective treatment and families are typically quite grateful. But what about the cases of Helicobacter-negative gastritis.  This is less straightforward.

A recent study (Genta RM, Sonnenberg A. Aliment Pharmacol Ther 2015; 41: 218-26 thanks to Ben Gold for this reference) provides some helpful data.  From a pathology national database, the authors reviewed 895,323 patient records from individuals with gastric biopsies (2008-2014).

Key findings:

  • 10.6% had Hp-gastritis. The prevalence of Hp-gastritis declined mildly from 11.2% in 2008 to 9.9% in 2014.
  • 1.5% had Hp-negative gastritis.  The prevalence of Hp-negative gastritis declined from 2.1% in 2008 to 1.1% in 2014.
  • In patients with Hp-negative gastritis who underwent a repeat endoscopy, on average 18 months after index biopsy, 7.4% had detectable Helicobacter pylori.  Thus, a small number of Hp-negative gastritis may represent a missed infection.
  • The authors note that only 3.5% of Hp-negative gastritis was associated with inflammatory bowel disease (IBD).

It is well-recognized that there are many limitations with analyzing databases.

Take-home message: Given the limited amount of information about Hp-negative gastritis, this study is helpful by indicating that only a small fraction represent a missed case of H pylori and a smaller fraction have coexistent IBD.  With improvements in microbiology, perhaps more clarity will emerge to determine what Hp-negative gastritis is rather than what it isn’t.

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