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H. pylori-related gastritis 2 (Clinical features (Asymptomatic (but may …
H. pylori-related gastritis 2
Morphology
Intestinal metaplasia
goblet cells
Nuclei are located
on the basement
membrane and
secreting mucin.
High grade dysplasia
Metaplasia could progress
to dysplasia, cells are basally
located and are going to
be very atypical and vary in
size and shape, also have a
larger, hyperchromatic
nucleus.
Nuclei are
haphazardly
arranged
(they don’t respect each other).
Loss of polarity
This is a very
fertile environment
for
developing
adenocarcinoma
Organisms are seen within
the mucus layer overlying the
superficial mucosal
epithelium (noninvasive), so
they will be found inter not
intra cellular.
Complications
Clinical features
Upper abdominal discomfort, Nausea &
Vomiting
May be hypochlorhydric (pangastritis), but
these persons do not develop
achlorhydria or pernicious anemia
Asymptomatic
but may
present with epigastric pain
, discomfort, nausea and vomiting
Serum gastrin levels are either normal or
only modestly elevated
Diagnosis
Noninvasive tests
Fecal bacterial detection
The urea breath test based on
the generation of ammonia
by bacterial urease
Serologic test for
anti–H. pylori antibodies
Invasive tests
(Antral biopsy specimen)
The rapid urease test,
bacterial culture, or PCR
• Histologic identification of the
organism. (By using stains like
giemsa and
silver stains)
Treatment
Triple therapy (two antibiotics and PPIs -proton pump inhibitors-)
Hard to treat, patient should comply with treatment.
