Abstract
A 66-year-old male farmer pre-sented at the Unit of Gastroenterology,Policlinico Hospital, University of Bari,Bari, Italy, with a 1-year history of dys-phagia upon both solid and liquid foodintake, belching, occasional vomiting,and weight loss. His medical history in-cluded pulmonary emphysema, surgeryfor inguinal hernia, and hypertension.Endoscopy revealed the presence ofchronic esophagitis, hiatal hernia, andantral erosions. The bulb was hyper-emic. The mucosa of the remainingduodenum appeared normal. Multiplebiopsy specimens were taken from theesophagus, gastric body and antrum,and the duodenal bulb. The esophagealhistology revealed epithelial acanthosiswithout gastric and intestinal metapla-sia. Histology showed moderate chronicantral gastritis, as demonstrated by anincreased number of lymphocytes andplasma cells in the lamina propria withseveral polymorphonuclear cells (Fig. 1).The gastric body histology was normal.The duodenal bulb showed a chronicinflammation associated with small fociof gastric metaplasia. Gram-stainedsmears of sections of the gastric antrumand duodenal gastric metaplasia revealedseveral gram-negative, tightly coiled,spiral-shaped bacteria resembling
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