Heilmannii Gastritis Research Articles

Helicobacter heilmannii gastritis in a young patient with a pet

A 17-year-old man with familial adenomatous polyposis was evaluated for heartburn. On EGD, mildly erythematous and micronodular mucosa was seen in the gastric corpus and antrum (A). Biopsy specimens revealed chronic inactive gastritis (B) with focally prominent intraepithelial lymphocytes resembling so-called lymphoepithelial lesions (C; arrowheads). A Giemsa stain revealed relatively long (5-10 μm), tightly coiled organisms on the gastric surface and within crypts (D). The organisms reacted in a routine immunohistochemical stain for Helicobacter pylori (D; inset); however, electron microscopy (E) highlighted ultrastructural features of the microbes (3-8 coils, about 1 μm helical pitch) leading to the diagnosis of Helicobacter heilmannii gastritis. A species-specific polymerase chain reaction that used genomic DNA extracted from the biopsy specimen was positive (F; M, DNA ladder; lane 1, no input DNA [negative control]; lane 2, H heilmannii DNA [positive control]; lane 3, H pylori DNA [negative/specificity control]; lanes 4 to 5, biopsy samples; expected product [arrowhead], 587 base pairs). H heilmannii is significantly larger and more tightly coiled than H pylori (G). Our patient received H heilmannii eradication treatment with clarithromycin, metronidazole, and omeprazole with complete relief of his symptoms. Further follow-up testing was declined.

A Report of Two Children withHelicobacter HeilmanniiGastritis and Review of the Literature

An 11-year-old boy with epigastric abdominal pain and a 2 year-old girl with failure to thrive underwent esophagogastroduodenoscopy. Endoscopic biopsies from the gastric antrum of both children revealed corkscrew-like spiral bacteria, consistent with the diagnosis of Helicobacter heilmannii infection. H. heilmannii is a rare finding in children and is thought to be present in approximately 0.3% of patients undergoing upper endoscopy. Clinical presentation, gross and histologic appearance, and treatment regimens are discussed. The clinical and histologic features of previously reported cases of H. heilmannii gastritis in children living in the United States are reviewed in table form.

Acute Symptomatic Gastritis Due to Helicobacter heilmannii

Helicobacter heilmannii is a Gram-negative spiral-shaped organism predominantly associated with zoonotic infection. Human pathology has also been described, but acute symptoms with complete resolution have been infrequently reported. We present a 50-year-old man in whom H. heilmannii gastritis presented as an acute febrile illness and was successfully treated with antibiotics and proton pump inhibitor. Epidemiology, diagnosis, and treatment of similar cases are reviewed.

A report of two children with Helicobacter heilmannii gastritis and review of the literature

A report of two children with Helicobacter heilmannii gastritis and review of the literature

Helicobacter Heilmannii Gastritis

H. heilmannii belongs to the Helicobacter family and is found in a small number of gastric biopsies. This bacterium is generally found in primates, cats, pigs, and carnivorous mammals. About 0.5% to 6% of human gastric infections have been attributed to H. heilmannii. The bacterium usually induces mild chronic gastritis but may be associated with peptic ulceration, and rare cases were reported in association with gastric carcinoma and mucosa-associated lymphoid tissue lymphoma. We report a case of H. heilmannii chronic gastritis in a 44-year-old man with a history of chronic heartburn, found to have erythema and granularity in the antrum. Antral biopsy showed mild chronic gastritis with prominent lymphoid aggregates, and rare long, thin, spiral bacilli were present adjacent to the surface epithelium. The long tightly coiled morphology suggestive of H. heilmannii was obvious at 1000 x magnification. The lack of information in the literature regarding cross-reactivity of H. heilmannii to commercially available antibodies used for immunohistochemical detection of H. pylori prompted us to evaluate whether commercially available polyclonal anti-H. pylori antibodies show cross-reactivity between the two organisms. The H. pylori immunostain highlighted H. heilmannii organisms and their characteristic morphology, confirming cross-reactivity with the anti-H. pylori polyclonal antibody. This case illustrates the potential contribution of commercially available polyclonal antibodies against H. pylori to help confirm a diagnosis of H. heilmannii gastritis. The use of immunohistochemical stain to identify H. heilmannii may be useful in cases with a paucity of organisms, with suggestive but not diagnostic forms on routine hematoxylin and eosin stain.

Helicobacter heilmannii gastritis: a histological and immunohistochemical trait.

Biopsies of the gastric antrum were reviewed over a period of 10 years to determine the prevalence of Helicobacter heilmannii in symptomatic subjects from this geographical area and to relate its presence to distinctive histopathological and immunohistochemical features. Biopsies from 7926 symptomatic patients were reviewed. Ten serial sections were stained with haematoxylin and eosin for conventional histology. Another 10 sections were stained with the Gram method for spiral bacteria. When H heilmannii was suspected, 10 additional serial sections were stained with methylene blue to obtain homogeneous colouring. An equal number of sections from patients affected by isolated H heilmannii or H pylori gastritis were analysed by immunohistochemistry to evaluate lymphoid aggregate/mucosal lymphocyte clonality (CD20 and CD3) and tumour necrosis factor alpha (TNF-alpha) in stromal cells. The prevalence of H heilmannii was 0.1% (eight of 7926), whereas H pylori was present in 60.7% of patients (4813 of 7926). In two of the eight H heilmannii positive patients both helicobacters were found. In all subjects infected by H heilmannii only, distinctive histology (lymphocyte exudation into gastric foveolae) was seen. Lymphoid aggregates, chronic mucosal inflammation with patchy activity, and the absence of epithelial mucus depletion were regular features of H heilmannii gastritis. Immunohistochemistry did not reveal different lymphocyte clonal patterns between H pylori and H heilmannii gastritis: CD20 positive cells were predominant in the centre of aggregates and mucosal infiltrates, whereas CD3 positive cells were prevalent at the periphery of follicles. Only H pylori gastritis showed a significant increase in TNF-alpha positive stromal cells. These data suggest that an unusual lymphocyte reaction, with the tendency to invade the foveolar lumen, is a distinctive histopathological aspect of H heilmannii chronic gastritis, although further studies in a larger series are necessary to confirm this fact. Nevertheless, lymphocyte clones do not differ qualitatively from those found in H pylori infection. Moreover, compared with H heilmannii, H pylori provokes a more intense release of TNF-alpha, suggesting that different inflammatory responses exist to these two organisms.

Animal reservoirs in the transmission of Helicobacter heilmannii: Results of a questionnaire-based study

Background: Infection with either Helicobacter heilmannii or H. pylori causes gastritis in humans. Whereas the route of transmission of H. pylori appears to be human-human, it has been suggested that H. heilmannii is transmitted by animals. Methods: Two hundred and two patients with histologically confirmed H. heilmannii gastritis and 600 randomly selected patients with H. pylori gastritis were sent a questionnaire, in which they were asked whether they had had or still have regular contact with dogs, cats, rodents, horses, birds, cattle, pigs, or wild animals. Results: The questionnaires of 177 patients with H. heilmannii and 485 with H. pylori infection were evaluated. In comparison with H. pylori, H. heilmannii infection was strongly associated with contact with dogs, cats, cattle, or pigs. Logistic regression analysis showed that contact with pigs, cats, and dogs leads to a significant risk of H. heilmannii infection (odds, 4.990, 1.710, and 1.462). Conclusion: Pigs, cats, and dogs appear to be reserv...

Animal Reservoirs in the Transmission of Helicobacter heilmannii: Results of a Questionnaire-Based Study

Background: Infection with either Helicobacter heilmannii or H. pylori causes gastritis in humans. Whereas the route of transmission of H. pylori appears to be human-human, it has been suggested that H. heilmannii is transmitted by animals. Methods: Two hundred and two patients with histologically confirmed H. heilmannii gastritis and 600 randomly selected patients with H. pylori gastritis were sent a questionnaire, in which they were asked whether they had had or still have regular contact with dogs, cats, rodents, horses, birds, cattle, pigs, or wild animals. Results: The questionnaires of 177 patients with H. heilmannii and 485 with H. pylori infection were evaluated. In comparison with H. pylori, H. heilmannii infection was strongly associated with contact with dogs, cats, cattle, or pigs. Logistic regression analysis showed that contact with pigs, cats, and dogs leads to a significant risk of H. heilmannii infection (odds, 4.990, 1.710, and 1.462). Conclusion: Pigs, cats, and dogs appear to be reservoirs in the transmission of H. heilmannii.

TWO CASE REPORT OF HELICOBACTER HEILMANNII GASTRITIS WITH ENDOSCOPIC FEATURES RESEMBLING HELICOBACTER PYLORI GASTRITIS

Helicobacter Heilmannii (also known as gastrospirillum hominis) has been reported as the cause of gastritis. We report two cases of helicobacter heilmanni gastritis with endoscopic features resembling helicobacter pylori gastritis. Our patients were 4 and 11 year old children who presented with history of severe abdominal pain, vomiting which required multiple visits to the emergency department and in one case an admission to the hospital. Both patients had work up that included electrolytes, amylase, lipase, and liver function tests which failed to identify the cause of their symptoms. Radiological evaluation was negative for anatomical obstruction. One patient had normal abdominal ultrasound. Patients were seen in consultation by the pediatric gastroenterology service two weeks after the onset of the symptoms. both patients underwent esophagogastroduodenoscopy. Both patients had evidence of active gastritis with nodular gastric mucosa which resembled the appearance of helicobacter pylori (HP) gastritis. The pathological evaluation was negative for HP and positive for the presence of corkscrew-like spiral bacteria compatible with helicobacter helmannii. One patient had Clotest and HP antibodies tests done and both were negative. Both patients were treated with H2 blocker, clarithromycin and amoxicillin with remarkable resolution of symptoms within few days. Conclusion: Helicobacter heilmannii (HH) gastritis is a cause of acute abdominal pain in children. HH gastritis has an endoscopic appearance that resembles HP gastritis. HH gastritis seems to respond well to treatment with H2 blockers, clarithromycin and amoxicillin.

A Comparison of Helicobacter pylori and H. heilmannii Gastritis: A Matched Control Study Involving 404 Patients

Background: Since Helicobacter heilmannii gastritis is very much rarer than H. pylori gastritis, and no systematic studies comparing these two gastritides have so far been carried out, we undertook the present study to investigate possible differences between H. heilmannii and H. pylori gastritis. Methods: In 202 patients with H. heilmannii gastritis and 202 matched control patients with H. pylori gastritis and duodenal ulcer the following variables were graded and compared: Helicobacter colonization, chronicity of gastritis, activity of gastritis, replacement of foveolar epithelium by regenerative epithelium, mucus depletion, frequency of acquired mucosa-associated lymphoid tissue (MALT), and intestinal metaplasia. Results: In contrast to the diffuse pattern of colonization in the case of H. pylori, colonization with H. heilmannii is mainly (91.2%) focal and for the most part restricted to the antrum (only 29.1% concurrent colonization of the corpus). The gradings of all gastritis variables were statistically highly significantly milder in the case of H. heilmannii gastritis. In addition, intestinal metaplasia and acquired MALT were significantly less common in patients with H. heilmannii infection. The rare cases of erosions (n=8) and ulcerations (n=8) in H. heilmannii gastritis were usually associated with the use of non-steroidal antiinflammatory drugs. In a single case of H. heilmannii gastritis a concurrent gastric carcinoma and in seven cases a low-grade gastric MALT lymphoma were found. Conclusion: In contrast to H. pylori infection the rare colonization of the gastric mucosa with H. heilmannii, mainly circumscribed and mostly in the antrum, induces a very much milder form of gastritis in the antrum and corpus, which may also be the reason for the rarity of concurrent erosions and ulcers. Whether the observed relatively frequent association of H. heilmannii infection and gastric MALT lymphoma is coincidental, and whether H. heilmannii gastritis is more commonly associated with MALT lymphoma than is H. pylori gastritis must be investigated in further studies.

Helicobacter heilmannii (formerly Gastrospirillum hominis) gastritis: an infection transmitted by animals?

The source of infection with Helicobacter heilmannii (formerly Gastrospirillum hominis), a relatively rare causative agent of gastritis in humans, is not clear. It has long been known that this organism occurs in the stomach of domestic animals and pets. By performing an epidemiologic investigation on possible contact of patients with Helicobacter heilmannii gastritis with such animals, we made an attempt to gain further information about the source of infection. Of 125 patients with confirmed H. heilmannii infection, 111 provided us with information about contact with animals. Some 70.3% of the patients had contact with one or more animals (as compared with 37% in the 'normal' population); 73% were males, and 1.6% had concomitant infection with H. pylori. Our analysis indicates that H. heilmannii gastritis is due to its transmission to humans by domestic animals or pets. Concomitant infections by H. heilmannii and H. pylori are very rare, and it is possible that H. heilmannii might protect from infection with H. pylori. However, the results of our retrospective analysis will have to be tested against those of a prospective study investigating the day-to-day situation of the individual patients in greater detail and also be compared with patients not infected with H. heilmannii.