Helicobacter pylori -Negative Gastritis: Prevalence and Risk Factors

Abstract

OBJECTIVES Recent studies using histology alone in select patients have suggested that Helicobacter pylori-negative gastritis may be common. The objective of this study was to investigate the prevalence of H. pylori among individuals with histologic gastritis. METHODS Subjects between 40 and 80 years underwent elective esophagogastroduodenoscopy at a VA Medical Center. Gastric biopsies were mapped from seven prespecified sites (two antrum, four corpus, and one cardia) and graded by two gastrointestinal pathologists, using the Updated Sydney System. H. pylori-negative required four criteria: negative triple staining at all seven gastric sites, negative H. pylori culture, negative IgG H. pylori serology, and no previous treatment for H. pylori. Data regarding tobacco smoking, alcohol drinking, nonsteroidal anti-inflammatory drug, and proton pump inhibitor (PPI) use were obtained by questionnaire. RESULTS Of the 491 individuals enrolled, 40.7% (200) had gastritis of at least grade 2 in at least one biopsy site or grade 1 in at least two sites. Forty-one (20.5%) had H. pylori-negative gastritis; most (30 or 73.2%) had chronic gastritis, five (12.2%) had active gastritis, and six (14.6%) had both. H. pylori-negative gastritis was approximately equally distributed in the antrum, corpus, and both antrum and corpus. Past and current PPI use was more frequent in H. pylori-negative vs. H. pylori-positive gastritis (68.2% and 53.8%; P = 0.06). CONCLUSIONS We used multiple methods to define non-H. pylori gastritis and found it in 21% of patients with histologic gastritis. While PPI use is a potential risk factor, the cause or implications of this entity are not known.

Helicobacter-pylori Negative Gastritis in Children—A New Clinical Enigma

“…In recent publications, the topic of Hp-negative gastritis in adult patients has been raised by a few investigators. In a prospective analysis of 491 adult patients, Nordenstedt et al evaluated the rate of gastritis and its associated pathology and confounding factors [18]. In this study the authors demonstrated gastritis in 200 (40.7%) patients of whom 41 (20.5%) were Hp-negative.…”

“…Of the confounding factors, alcohol consumption and smoking were significantly associated with Hp-negative gastritis but not drugs (PPI, NSAID). The authors concluded that the "causes and implications of this entity (Hp-negative gastritis) are unknown and worthy of future studies" [18]. In an editorial that followed this report the author reminded us of the other common reasons for missing the bacterium in the biopsies of adult patients including: sampling error, or chronic use of PPI and antibiotics [19].…”

Changing prevalence ofHelicobacter pyloriinfection in the 9th district of Budapest. A retrospective endoscopic study, 1997–2012

“…Érdekesség, hogy protonpumpagátlók aktuális szedése 1,68-ra (95% KT: 0,78-3,66) növelte a H. pylori-negatív gastritis esélyhányadosát, felvetve az újabb etiológiai tényezők szerepét [39].…”

Influence of proton pump inhibitors on gastritis diagnosis and pathologic gastric changes

“…In our non-H. pylori gastritis group, the proportions of true H. pylori negative gastritis and masked H. pylori gastritis remain to be determined. Nordenstedt et al [25] have addressed the prevalence of true H. pylorinegative gastritis. [26,27] .…”