Varioliform Gastritis — An Endoscopic Presentation Form of Helicobacter Pylori

Abstract

JL Hedenbro, K Offenbartl, R Willen, Varioliform Gastritis -An Endoscopic Presentation form of Helicobacter Pylori. 1995; 15(5): 532-534 There are two forms of gastric erosion -incomplete and complete. The latter type is, when occurring multiply, known as "varioliform gastritis", as named by Moiter and Martin.1 In contrast to the NSAID-related incomplete erosions, this type of erosion is of obscure origin. Through the endoscope, they appear as small nodules with central erosions, usually on the top of somewhat swollen gastric folds. They are covered with a whitish exudate, sometimes with an erythematous margin 2 and may occur in the antrum or in the body of the stomach. On histology, the lesions comprise large numbers of inflammatory cells. 3 The etiology of this condition is not understood. The term "lymphocytic gastritis" has been coined and an allergic-etiology suggested due to the finding of increased numbers of immunoglobulin E-producing plasma cells in the lesions. Patients And ResultsDuring a 17-month period, we found 34 patients with no pathology visible on upper GI endoscopy other than multiple gastric erosions confined to the antrum, 10 with the appearance of complete erosions and 24 with incomplete erosions. The patients with complete erosions were eight women and two men, ages 35 to 48 years. The patients with incomplete erosions were 16 women and eight men, ages 28 to 60 years. The indication for endoscopy was epigastric pain or evidence of upper gastrointestinal bleeding. A summary of patient material and findings is given in Table 1.Two patients with complete erosions admitted to regular or recent NSAID intake, whereas 18/24 patients with incomplete erosions did (P=0.0054; two-tailed Fisher's exact test). The pathological findings at endoscopy were confined to the prepyloric region. Patients in the group labeled "complete erosions" all had partially confluent nodules on top of swollen antral folds, with central fibrincovered erosions, some of which were surrounded by erythematous halos (Figure 1). Incomplete erosions were defined endoscopically as distinct, shallow mucosal defects on top of the antral folds. They often had a small hematin base and the folds were not swollen. Multiple biopsies were sent for routine histology as well as for Warthin-Starry staining. 6 This latter method has a high sensitivity and specificity for the presence of Helicobacter pylori.7 Additional cultures were sent for H. pylori culture 8 and blood was obtained for H. pylori serology. 9Histological sections stained with hematoxylin and eosin demonstrated identical findings in the cases with complete erosions. The mucosa on the surface of the lesions was eroded and covered with fibrin. There were granulocytes and severe infiltration of lymphocytes and plasma cells in the lamina propria. Only a few lymphocytes were detected within epithelial cells but some granulocytes and plasma cells were present. There was hyperplasia of the surface epithelial cells together with a severe inflammatory atypia and glandular atrophy (...