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 anti-inflammatory 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.