13. Helicobacter heilmanii related gastritis in humans: presentation of 2 new cases with PCR confirmation and review of the literature

Abstract

We present two cases of <i>Helicobacter heilmannii</i> (Hh) associated gastritis. A 37-year-old lady presented with 4 weeks history of dysphagia and dyspepsia. Gastroscopy showed 3–4 small punched out erosions with raised edges in the antrum. Her Campylobacter-like organism (CLO) test was positive. Biopsies showed chronic gastritis with numerous Gram-negative bacteria that were corkscrew shaped, larger and longer compared to <i>H. pylori</i>. The characteristic features were suggestive of Hh and this was subsequently confirmed by polymerase chain reaction (PCR). The histology also showed florid lymphoid infiltration suspicious of a low grade B cell lymphoma. She was successfully treated with <i>H. pylori</i> eradication treatment. Subsequent biopsies showed chronic active gastritis with milder lymphoid infiltration. An 82-year-old man had 10 years history of intermittent epigastric discomfort. Gastroscopy showed antral gastritis and patchy duodenitis. His CLO test was positive. The histology showed antral foveolar cell hyperplasia, moderate mixed inflammatory infiltrate and many spiral organisms morphologically consistent with Hh. This was confirmed by PCR on formalin fixed, paraffin embedded tissue. He received <i>H. pylori</i> eradication treatment but was lost to follow up. <h3>Discussion</h3> Hh gastritis is rare and is generally considered as zoonosis from pet animals. The presence of unusual lymphocy-tereaction with the tendency to invade the foveolar lumen are distinctive features of Hh chronic gastritis. The morphology of the bacteria is characteristic. Serology, CLO test and immuno-histochemistry cannot distinguish between the <i>Helicobacter</i> species.