COMPARISON OF HELICOBACTER-PYLORI AND HELICOBACTER-HEILMANNII GASTRITIS - MATCHED CONTROL STUDY INVOLVING 404 PATIENTS

Background: Since Helicobacter heilmannii gastritis is very much rarer than H, pylori gastritis, and no systematic studies comparing these t wo gastritides have so far been carried out, we undertook the present study to investigate possible differences between H. heilmannii and H. pylori gastritis. Methods: In 202 patients with H. heilmannii gastrit is and 202 matched control patients with H. pylori gastritis and duode nal ulcer the following variables were graded and compared: Helicobact er colonization, chronicity of gastritis, activity of gastritis, repla cement of foveolar epithelium by regenerative epithelium, mucus deplet ion, frequency of acquired mucosa-associated lymphoid tissue (MALT), a nd intestinal metaplasia. Results: In contrast to the diffuse pattern of colonization in the case of H, pylori, colonization with H. heilman nii is mainly (91.2%) focal and for the most part restricted to the an trum (only 29.1% concurrent colonization of the corpus). The gradings of all gastritis variables were statistically highly significantly mil der in the case of H. heilmannii gastritis. In addition, intestinal me taplasia and acquired MALT were significantly less common in patients with H. heilmannii infection. The rare cases of erosions (n = 8) and u lcerations (n = 8) in H. heilmannii gastritis were usually associated with the use of non-steroidal antiinflammatory drugs. In a single case of H. heilmannii gastritis a concurrent gastric carcinoma and in seve n cases a low-grade gastric MALT lymphoma were found. Conclusion: In c ontrast to H. pylori infection the rare colonization of the gastric mu cosa with H, heilmannii, mainly circumscribed and mostly in the antrum , induces a very much milder form of gastritis in the antrum and corpu s, which may also be the reason for the rarity of concurrent erosions and ulcers. Whether the observed relatively frequent association of H. heilmannii infection and gastric MALT lymphoma is coincidental, and w hether H. heilmannii gastritis is more commonly associated with MALT l ymphoma than is H. pylori gastritis must be investigated in further st udies.