Helicobacter heilmannii gastritis: Association with acid peptic diseases and comparison with Helicobacter pylori gastritis

We analyzed 2 antral and 1 corpus full-thickness random endoscopic gastric mucosal samples obtained from 946 patients with duodenal ulcers (6077 biops ies) and from 281 patients with nonsteroidal anti-inflammatory drug-associa ted gastric ulcers (1794 biopsies). We stained tissue sections with hematox ylin and eosin and Warthin-Starry silver stain and immunostained them with polyclonal antibodies against Helicobacter pylori Hematoxylin- and eosin-st ained sections from 6 patients with Helicobacter heilmannii (18 biopsies) a nd 23 randomly selected patients with H. pylori (68 biopsies) were evaluate d and semiquantitated for the presence of acute inflammation, chronic infla mmation, glandular atrophy, intestinal metaplasia, H. pylori, H. heilmannii , lymphoid follicles, or vasodilatation, Additional specimens were obtained for H, pylori culture, a CLO test, and serologic examination. H. heilmanni i was detected in 6 (0.49%) of 1227 patients (14 [0.18%] of 7871 biopsies). Of these, 4 (0.42%) of 946 were patients with duodenal ulcers (9 [0.15%] o f 6077 biopsies), and 2 (0.71%) of 281 were patients with nonsteroidal anti -inflammatory drug-associated gastric ulcers (5 [0.28%] of 1794 biopsies). We found H. heilmannii with hematoxylin and eosin stain, Warthin-Starry sta in, and immunoperoxidase stain for H. pylori. Culture for H. pylori was neg ative in the four patients with duodenal ulcers. The CLO and serologic test s were positive in three of five and five of five patients, respectively. O ur results indicate that H. heilmannii, like H. pylori, is associated with peptic ulcer disease (both active and inactive gastritis) and that it prefe rentially colonizes the gastric antrum. The severity of the H. heilmanii-as sociated gastritis is less intense and lymphoid aggregates are less common than in H. pylori-associated gastritis. Morphologic detection seems to be t he method of choice for detecting H, heilmannii Immunoperoxidase stain spec ific for H, pylori also stains H, heilmannii, indicating cross-reacting ant igenic epitopes between H, heilmannii and H, pylori.