2758 Lymphocytic Gastritis With Hypoproteinemia Treated With Helicobacter pyloriEradication

Abstract

INTRODUCTION: Lymphocytic gastritis with hypoproteinemia is a rare condition and has been associated with Helicobacter pylori infection. We present the case of a 59-year-old female with hypoproteinemia associated with lymphocytic gastritis. The hypoproteinemia resolved after eradication of H. pylori. CASE DESCRIPTION/METHODS: The patient is a 59-year-old female who presented with complaints of early satiety. She had lost fifteen pounds over a period of six months. The patient had no other significant past medical history, and her clinical examination was normal except for minimal epigastric tenderness. She had no signs of malnutrition and did not have chronic diarrhea. On routine workup, she was found to have low total protein and normal albumin. Total protein on initial presentation was 5.4 g/dL. Eight weeks later, her total protein was still low (5.5 g/dL) with slightly low albumin (3-4 g/dL) as well. She had normal liver function tests and a negative celiac screening. Upper endoscopy revealed some patchy erosion of the antrum and thick gastric folds in the proximal body. Biopsies from the antrum and body revealed severe lymphocytic gastritis with chronic active inflammation. There were significant surface and foveolar epithelial infiltration by T lymphocytes (more than thirty lymphocytes per 100 epithelial cells). Immunohistochemical staining did not show Helicobacter pylori, but she did have positive H. pylori antibodies in the serum. The patient was treated with triple therapy for two weeks. Six weeks after eradication of H. pylori, her total protein increased to 7.5 g/dL. She also gained six pounds and was asymptomatic. DISCUSSION: Very few cases of lymphocytic gastritis-associated hypoproteinemia that resolved after eradication of H. pylori have been described in literature. Previous reports indicate that eradication of H. pylori is associated with prompt and significant improvement of hypoproteinemia as well as eventual disappearance of lymphocytic gastritis. Studies have suggested that lymphocytic gastritis condition is likely a rare and specific immune response to H. pylori. Links have also been described between lymphocytic gastritis and celiac disease as well as between lymphocytic gastritis and varioliform gastritis. This case serves to further establish an etiological link between H. pylori infection and lymphocytic gastritis accompanied by a protein-losing state.