S2977 Incidental Finding of Helicobacter Heilmannii in Two Asymptomatic Individuals

Abstract

INTRODUCTION: Helicobacter heilmannii previously known as Gastrospirillum hominis is commonly seen in animals and may have zoonotic potential. It contributes to about 5% of human gastric infections, resulting in chronic gastritis, peptic ulceration, and rarely gastric carcinoma or mucosa-associated lymphoid tissue lymphoma. Most patients are symptomatic and present with dyspepsia, epigastric pain, or acid reflux. We report two cases in which incidental H.Heilmannii was found in the pathological report. CASE DESCRIPTION/METHODS: Both our patients had undergone esophagogastroduodenoscopy (EGD) in anticipation of bariatric surgery. One is a 22-year-old morbidly obese female without significant medical illness, who had mild patchy erythematous mucosa in the gastric antrum. Biopsy revealed moderate to severe chronic active gastritis. Both H.pylori and H.heilmannii organisms were identified on the Hematoxylin and eosin (H&E) stain. Next is a 25-year-old morbidly obese female with gastroesophageal reflux disease. Her EGD also revealed mild patchy erythematous mucosa in the gastric antrum and biopsy showed moderate inactive gastritis, reactive lymphoid follicles, and frequent long tightly coiled bacteria highlighted on H&E stain consistent with H.heilmannii. They were both treated with a 2-week course of amoxicillin, clarithromycin, and omeprazole. They remained asymptomatic during subsequent office visits and are scheduled for follow up EGD after their bariatric surgery. DISCUSSION: Gastric inflammation in humans infected with H.heilmannii is less severe and usually involves the gastric antrum like seen in our patients. Co-infection of H.heilmannii and H.pylori is often seen and is believed to have a higher prevalence of intestinal metaplasia than does infection with either strain alone. Studies have highlighted that H.heilmannii like H.pylori, is effectively eradicated with similar antimicrobial therapy. We are however unable to detect the presence or confirm eradication via ancillary tests such as urea breath test, serum antibody testing, or stool testing as with H.pylori. Whether in symptomatic patients or with incidental chronic gastritis findings, it is prudent to look for H.heilmannii in the absence of, or concomitant with H.pylori infection and treat them adequately to prevent further complications.Figure 1.: Antral mild chronic active gastritis - H&E stain, 10x.Figure 2.: Antral moderate chronic active gastritis - H&E stain, 10x.Figure 3.: Long tightly coiled organisms with corkscrew appearance, consistent with Helicobacter heilmannii - H&E stain, 100x, oil.