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Prevalence and pattern of Helicobacter pylori gastritis in the gastric cardia
A Hackelsberger1, T Günther, V Schultze
1Department of Gastroenterology, Otto-von-Guericke-University of Magdeburg, Germany.
Insights
Helicobacter pylori gastritis frequently affects the cardia, though bacterial density is lower there than in the antrum. Intestinal metaplasia is common in the cardia of these patients.
Area of Science:
- Gastroenterology
- Microbiology
- Pathology
Background:
- Helicobacter pylori typically colonizes the gastric antrum.
- Gastric acid production influences H. pylori colonization patterns.
- Lower acid production in the cardia suggests potential for H. pylori colonization.
Purpose of the Study:
- To investigate the histologic pattern of gastritis in the cardia.
- To determine the prevalence of H. pylori in the cardia compared to the antrum and corpus.
- To assess the association between H. pylori, gastritis, and intestinal metaplasia in the cardia.
Main Methods:
- Biopsies from the antrum, corpus, and cardia of 135 H. pylori-infected patients were analyzed.
- Histologic examination assessed gastritis prevalence, topography, and bacterial presence.
- Staining techniques identified H. pylori and evaluated bacterial density.
Main Results:
- H. pylori gastritis was present in 97.7% of cardia biopsies.
- Cardia gastritis showed lower bacterial density and inflammatory response compared to the antrum.
- Intestinal metaplasia was found in 20.7% of cardia biopsies, similar to the antrum (23.7%).
Conclusions:
- H. pylori gastritis commonly involves the gastric cardia.
- Bacterial density and inflammation are reduced in the cardia compared to the antrum.
- Intestinal metaplasia is a frequent finding in the cardia of H. pylori-infected individuals, warranting further study in reflux patients.
Objectives:
Helicobacter pylori has a predilection for antral colonization. Local acid production is the major determinant of colonization. Because production is low in the antrum and cardia, H. pylori should also colonize the cardia. We therefore investigated the histologic pattern of gastritis and the prevalence of H. pylori in the cardia compared with the antrum and corpus.
Methods:
From 135 H. pylori-infected patients with gastritis, ulcer disease, or reflux esophagitis, biopsies were obtained from the antrum, corpus, and cardia. The prevalence, topography, and histologic parameters of gastritis were examined.
Results:
All 135 patients had active antral H. pylori gastritis: in the cardia, 132 of these patients (97.7%) showed active gastritis, and 124 patients (91.9%) had H. pylori visible on staining. Gastritis of the cardia in most patients resembled antral gastritis, but the density of bacteria and the inflammatory responses were less marked. The most striking finding in the cardia of patients with gastroesophageal reflux was a lower density of bacteria compared with antrum and corpus. Intestinal metaplasia was found in 32 patients in antral mucosa (23.7%) versus 28 patients in the cardia (20.7%), versus 11 patients in the corpus (8.1%), and was multifocal in 17 patients (12.6%).
Conclusions:
H. pylori gastritis commonly involves the cardia. The histologic density of the bacteria and inflammatory responses are lower than in the antrum. Intestinal metaplasia in the cardia is a common finding in H. pylori gastritis. The cause of the lower bacterial density in the cardia of patients with reflux esophagitis needs further investigation.