Helicobacter heilmannii Gastritis: Is Your Pet to Blame?

Abstract

Introduction: H. heilmannii is a spiral bacilli of Helicobacter family generally found in primates, cats, pigs, and carnivorous mammals. Rare incidences of infection in human populations have been reported. The bacterium usually induces mild chronic gastritis but is infrequently associated with peptic ulceration and rarely with gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. We report a case of H. heilmannii chronic gastritis.Figure 1Case: A 60 year female with past medical history of gastro esophageal reflux disease presented with epigastric discomfort along with nausea and two episodes of non-bloody vomiting. She had quit smoking many years ago and was not using NSAIDS. She lived at home with her husband and her dog. Mild epigastric tenderness was notable on examination and lab work was normal including a normal serum gastrin level. Mild fatty infiltration of the liver was evident on ultrasound and CT abdomen showed thickening and edema of the antrum and duodenal bulb. Endoscopy revealed multiple antral ulcers with surrounding edema with some ulcers having black eschar at the base. There were several linear ulcers in the second portion of duodenum. Biopsy showed marked reactive inflammatory changes without metaplasia. Immunohistochemical staining pattern was consistent with H.Heilmannii. She received 6 weeks of anti- H Pylori triple therapy. A follow up endoscopy showed resolution of ulcers with biopsy negative for the organism. Discussion: Helicobacter species other than H. pylori are also referred to as H. heilmannii-like organisms (HHLO's). These long tightly coiled bacteria residing in the stomach of hosts such as cats, dogs, and pigs. Studies suggest the transmission of HHLO's through these pet's saliva. H. heilmannii infection has been associated with peptic ulcer disease, gastric carcinoma, and gastric MALT lymphoma in humans. Most cases present with antral predominant gastritis. Interestingly some studies have also shown that incidence of MALT lymphomas is higher in patients with HHLO gastritis as compared to patients with H.Pylori gastritis making them a significant health challenge. Sensitivity of diagnostic tests, such as rapid urease test, urea breath test and blood antibody is not high for HHLOs. Due to variation in morphology with in same species PCR is more accurate diagnostic test compare to histology. Treatment is a course of triple therapy with emphasis on measures to prevent reinfection from pets.