A case of Helicobacter heilmannii-associated primary gastric mucosa-associated lymphoid tissue lymphoma achieving complete remission after eradication

Abstract

A 46-year-old man underwent gastrointestinal endoscopy while visiting the hospital for a general physical check-up. Coarse mucosa in the antrum with superficial erosions was found by endoscopic gastrointestinal examination, but no atrophic changes were seen in the corpus. Histopathological examination of gastric biopsy specimens revealed mucosa-associated lymphoid tissue (MALT) lymphoma. Although Helicobacter pylori was not detected in our patient, H. heilmannii was identified histologically and by polymerase chain reaction analysis, resulting in the diagnosis of H. heilmannii-associated gastric MALT lymphoma. We successfully eradicated H. heilmannii and achieved complete remission of gastric MALT lymphoma by antibiotic therapy. H. heilmannii usually causes milder gastritis than H. pylori, but it has been more closely associated with MALT lymphoma. As such, when H. pylori infection is excluded in patients with gastric MALT lymphoma, physicians should next consider the possibility of H. heilmannii. Furthermore, our research suggests that eradication therapy is effective for treatment of localized H. heilmannii-associated gastric MALT lymphoma.

The Resolution of <i>Helicobacter suis-</i>associated Gastric Lesions after Eradication Therapy

“…NHPH infection has been recognized to be restricted to the antrum in most cases ( 16 ). In previous Japanese adult cases, endoscopy of the NHPH-infected gastric mucosa revealed spotty redness, erosion, ulcers and nodular gastritis in the antrum while the corpus mucosa remained normal without mucosal atrophy ( 4 , 5 , 10 , 17 - 19 ). A recent case study proposed that a white marbled appearance in the gastric angle and antrum is a potential characteristic finding of the NHPH-infected gastric mucosa ( 20 ).…”

“…In Japan, the prevalence of H. suis is not high as that in China ( 1 ). Since the first case was reported in 1994 ( 10 ), H. suis infection has only been observed in a small number of cases with MALT lymphoma or nodular gastritis ( 4 , 5 ).…”

“…The eradication of gastric NHPHs have been performed using regimens that are used for H. pylori eradication. Most Japanese cases with gastric NHPH infection have been successfully eradicated with a triple therapy that included a proton pump inhibitor, amoxicillin and clarithromycin ( 4 , 5 , 17 , 20 ). In the present case, we used metronidazole because clarithromycin had previously been used to treat an upper respiratory infection.…”

“…Helicobacter suis, formerly named “ Helicobacter heilmannii type 1”, is one of the gastric NHPHs ( 3 ). H. suis infection has been shown to be associated with nodular gastritis ( 4 ) and mucosa-associated lymphoid tissue (MALT) lymphoma ( 5 ) in Japan. At present, H. suis is difficult to diagnose because of its lower urease activity in comparison to H. pylori ( 6 ) and there are no established methods to detect antibodies to H. suis ( 1 ).…”

First-line antibiotic therapy in Helicobacter pylori-negative low-grade gastric mucosa-associated lymphoid tissue lymphoma

“…Although the question of why a certain proportion of HP-negative gastric MALT lymphomas may respond to antibiotics remains unanswered, several crucial findings may support the following speculations: (1) HPE regimens may also eradicate other bacteria or Helicobacter -like bacteria, such as H . heilmannii that is associated with the development of gastric MALT lymphoma in humans 71 – 73 . For example, Morgner et al .…”