Histology ofGastritis and Helicobacter pylori

Dr. H. Uchida , Dep. of molecular pathology
Oita University Faculty of Medical Sciences

Anatomy of stomach

Histopathology of stomachmucosasubmucosa

Major cells in the stomach
1. Chief cell

pepsinogen, gastric lipase

2. Mucous neck cellmucin

3. Parietal cellHCl, Intrinsic factor* Endocrine cell

gastrin, histamine,endorphins, serotonin,cholecystokinin somatostatinMucous producing cells are onlyon the surface of mucosa.

A: Antrum

Almost all glands are
mucous producing cells.

B: Body
Mixture of parietal cells,
chief cells and endocrine cells.

Corpus

Mucous neck cells( )⇒producing mucin

Parietal cell (acidophilic cells) ( )⇒gastric acid:This extremely strong acid breaks down food and anyother foreign element such as bacteria.
Chief cell (basophilic cell) ( ) ⇒Produce pepsinogen.
Pepsinogen (inactivated) -> Pepsin (activated)

AntrumMucous neck cells ( ) ⇒producing mucin(Endocrine cells produce hormones such as gastrin,
histamine, endorphins, serotonin, cholecystokinin andsomatostatin) Not shown in this picture.

Pathogenesis of gastric ulcer

Robbins Basic Pathology, 9th edition

H. pylroi infection induces theinflammation in the stomach=Gastritis !

A classification of Gastritis due toH. pylori infection
Up-dated Sydney system
5 factors to determine the stage of gastritis
1) Density of H. pylori
B2) Neutrophil infiltration
A3) Mononuclear cell infiltration
4) Atrophy5) Intestinal Metaplasia
Judged with 2 sites of biopsy (antrum + corpus)

Updated Sydney system grading at glanceDixson et al 1996. Am J Surg Pathol

1) H. pylori (density)
H. pylori lives on the surface of the stomach,

Dixson et al 1996. Am J Surg Pathol

2) Infiltration of Neutrophil= Acute inflammation
Neutrophils are one of the first-responders of inflammatory
cells to migrate towards the site of inflammation.
Normal (0)Mild(1)Moderate(2)Marked (3)Dixson et al 1996. Am J Surg Pathol

3) Infiltration of Mononuclear cell
= Chronic inflammation
Mononuclear cells= Lymphocytes can be identified bytheir large single nucleus.
Normal (0)Mild(1)Moderate(2)Marked (3)Dixson et al 1996. Am J Surg Pathol

4) Atrophy ( Body and Antrum)
Chronic damage ofgastric mucosa

Judged by density ofits own glands (loss ofglands)

Dixson et al 1996. Am J Surg Pathol

Typical atrophy ( HE staining)

NormalEndoscopicfindings

Atrophy5) Intestinal metaplasia
Transformation of gastric epithelium into intestinal
type of epithelium(=goblet cells)
Normal (0)Mild(1)Moderate(2)Marked (3)Dixson et al 1996. Am J Surg Pathol

Intestinal metaplasia can be divided into twogroups(incomplete, complete) dependent on
the existence of Paneth cells
Incomplete type of IM
Paneth cell(-)

Complete type of IM

Paneth cell(+)

How to evaluate gastritis
by updated Sydney system?
Case study 1

ANTRUM NORMAL

Antrum, neutrophil:0, Monocyte:0, Atrophy:0, Intestinal metaplasia:0

CORPUS NORMAL

surface

Corpus, neutrophil:0, Monocyte:0, Atrophy:0, Intestinal metaplasia:0

Case Study 2
Inflammatory cells, atrophy and Intestinal metaplasia

Inflammatory cells,
Monocyte:1

Next slide

Corpus, neutrophil:1, Monocyte:1, Atrophy:0, Intestinal metaplasia:0

Neutrophil aggregation

Corpus, neutrophil:1, Monocyte:1, Atrophy:0, Intestinal metaplasia:0

Goblet cells (red arrow)
Sign of intestinal metaplasia

Decreased number of glands -> atrophy scoure=2
Antrum, neutrophil:2, Monocyte:3, Atrophy:2, Intestinal metaplasia:2

Case Study 3
Evaluation of H. pylori infection
H. pylori can be detected by staining

How to evaluate gastric specimen, by updated Sydney system, case study.
HE staining

Immunohistochemistrywith H. pylori AbGiemsa staining
H. pylori is in the mucous.

H. pylori ( )How to find Helicobacter pylori in the pathology slides?
1. Scan the slide at x100 magnification.
Check color first!
Color: blue -> sign of inflammation
Inflammatory cells are stained in blue

2. Scan the slide at higher magnification.
Check surface of mucosa!
If there are many bacteria, you can find HE staining.
But it is sometimes difficult to find.

Giemsa staining3. You can find H. pylori at thesurface of gastric mucosa.
As marked yellowx1000

Analysis of virulent factor of H. pylori
One of the most virulent factors of H. pylori is Cag A.
There is two types of CagA existed. One is Westerntype, the other is East Asia type.

Differences between Western CagA andEast Asian CagAEPIYA motif
Western CagA

East-Asian CagA

East Asian CagA specific (EAS) sequence: AINRKIDRINKIASAGKG

Uchida et al, Cancer Sci. 2008

How to detect high virulent H. pylori, Western vs. East Asian CagA?
- Immunohistochemical analysis of gastric specimen.

East Asian cagA(+)
H. pylori infection

a- EAS Ab.

a- H. pylori Ab.

Western cagA(+) H.
pylori infection

a- EAS Ab.

a- H. pylori Ab.

Assessment of gastritis due to H.
pylori infection

How to score gastritis with H.pylori ?
Updated Sydney system

Semi-quantitative variable
Score
Normal: 0
Mild: 1Moderate: 2
Marked:3
Semi-quantitative variable ≠ Continuous variables

H. pylori Ab
CagA Ab
East Asian
CagA Ab
Immunohistochemistry
AntrumBody

How to read a histological data.
AntrumSample ID

Body

NeutroMonoatrophy

IM

NeutroMonoatrophy

IM

a-Hp

CagA(b300)

a-EAS

01

102221110

Semi-quantitative variables
By Updated Sydney system

Hp density Hp density

Quantitative variable
0: Negative 1: Positive

12By Giemsa stain

How to analyze gastritis associated with H. pylori ?
-Statistical analysis H. Pylori Ab
CagA Ab
East Asian
CagA Ab
Immunohistochemistry
AntrumBody

How to read a histological data.
AntrumSample ID

Body

NeutroMonoatrophyIM

NeutroMonoatrophyIM

a-Hp

CagA(b300)

a-EAS

01102221110

Semi-quantitative variables
By Updated Sydney system

When you use statistical application,
Data type must be ordinal scale.
Average : cannot
Median: okHp density Hp density
1

Quantitative variable
0: Negative 1: Positive

Contingency table analysis, χ2 analysis

2By Giemsa stainSummary
1) Gastritis ; Updated Sydney system; check below
1) Density of H. pylori
2) Neutrophil infiltration
3) Mononuclear cell infiltration
4) Atrophy5) Intestinal Metaplasia
2) Find H. pylori by the staining with HE, Giemsa, Immunohistochemistry3) Look at the surface of the stomach for the detection of H. pylori