Extent, topography and symptoms of Helicobacter pylori gastrtitis. Phenotyping for accurate diagnosis and therapy?

Abstract

Helicobacter pylori gastritis, a very common condition, may lead to serious sequelae such as peptic ulcer, gastric carcinoma, and mucosa-associated lymphoid tissue lymphoma. Histological grading of the various gastritis parameters can help to identify the risk of these sequelae and thus improve the indication for prophylactic treatment of the H. pylori infection. This applies in particular to two types of "risk gastritis": gastritis of the duodenal ulcer phenotype and gastritis of the carcinoma phenotype. In the former the antrum shows pronounced inflammatory changes while only low-grade gastritis is seen in the corpus. In the latter, by contrast, the gastritis in the corpus is at least equally as severe as that in the antrum; in addition, intestinal metaplasia and focal atrophy is also frequently found in this phenotype. By establishing topographic grading of the gastritis in antrum and corpus the pathologist can therefore play the role of a "litmus test" for prophylactic H. pylori eradication treatment.