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Updated: Nov 23, 2025
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Beyond Helicobacter: dealing with other variants of gastritis-an algorithmic approach
Hala El-Zimaity1, Robert H Riddell2
1Dynacare Laboratories, Brampton, ON, Canada.
Insights
This review outlines diagnostic approaches for gastric biopsies lacking Helicobacter pylori. It details how to identify non-Helicobacter inflammation and gastropathies based on cellular patterns and specific features.
Area of Science:
- Gastroenterology
- Pathology
- Histopathology
Background:
- Gastric biopsies often present inflammation, necessitating differentiation from Helicobacter pylori-associated lesions.
- Non-Helicobacter findings require systematic evaluation based on inflammatory cell types and morphological features.
Purpose of the Study:
- To present a structured diagnostic approach for non-Helicobacter inflammation in gastric biopsies.
- To guide the differential diagnosis of gastropathies in the absence of Helicobacter pylori.
Main Methods:
- Review of diagnostic algorithms for gastric inflammation and gastropathy.
- Analysis of key histological features including inflammatory cell predominance, intraepithelial lymphocytosis, collagen bands, granulomas, and reactive changes.
- Consideration of epithelial changes in the context of hypergastrinaemia and proton pump inhibitor use.
Main Results:
- A systematic approach is presented to differentiate various causes of non-Helicobacter inflammation.
- Key features guiding diagnosis include specific inflammatory cell infiltrates and associated epithelial changes.
- Gastropathies, characterized by epithelial changes with or without inflammation, are discussed, particularly in relation to hypergastrinaemia.
Conclusions:
- Effective diagnosis of gastric biopsy findings hinges on a methodical approach beyond Helicobacter pylori identification.
- Recognizing patterns of inflammation and specific morphological features is crucial for accurate diagnosis of non-Helicobacter conditions.
- This framework aids in managing patients with complex gastric pathologies.
Abstract:
In daily practice, the presence of inflammation in gastric biopsies prompts a mental algorithm, an early question being whether the lesion present is Helicobacter-associated. If Helicobacter organisms are not found, then there is a further algorithm, governed by the predominant type of inflammatory cells present, and the presence of other features such as intraepithelial lymphocytosis, a subepithelial collagen band, granulomas, coexisting chronic inflammation, focality, and superimposed reactive changes including erosions and ulcers. Each of these generates its own differential diagnosis. If no inflammation is present, then the two major changes specifically looked for are the changes associated with hypergastrinaemia, by far the most common cause of which is treatment with proton pump inhibitors, and reactive changes. These may be present with and without accompanying inflammation, and, when the epithelial changes dominate, the term gastropathy is preferred. In this article, we present an approach to non-Helicobacter inflammation and gastropathies.
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