Are there three types of Helicobacter pylori gastritis

A normal or mildly abnormal fundal gland histology and its well-documented enlarged parietal cell mass. The critical evaluation of gastric biopsy published in this journal 30 years ago was uncertain regarding clinicopathologic correlations in gastritis. Although the two H. pylori gastritides other than DAG involve both antrum and body and become progressively abnormal discovery of the etiologic importance of Helicobacter pylori has greatly advanced our understanding of the pathogenwith time. In DAG, the fundal glands of the body do not become progressively more abnormal with the passage of esis of gastritis, several unsolved problems remain. A critical question is which histological patterns of H. pytime. More than 50 years ago, Robert Hebbel meticulously documented the differences in gastric mucosal hislori–induced gastritis are associated with different types of ulcer and cancer? tology in patients with duodenal compared with gastric ulcer. Most subsequent studies have confirmed Hebbel’s This viewpoint will mainly address the variations in the histological patterns of H. pylori gastritis and their findings, but none are as extensive and well controlled as his classic description. The patterns of H. pylori gastriassociated diseases. Much of the data are not of the quality or quantity to justify final conclusions. Nevertheless, crittis are well described in a preliminary endoscopic study that is outstanding because of the extensive biopsy samical reevaluation may be worth undertaking now because of some new studies relating H. pylori to various types pling and the suitability of the controls. H. pylori–DAG is the pattern of which I am most confident because I of gastritis. Also, there are some observations in the older literature that merit reconsideration. I now believe that have been able to recognize it on blinded review of gastric biopsy specimens in 92% of 311 patients with endoscopithere is evidence for three kinds of HP gastritis: the first associated with duodenal ulcer, the second with gastric cally proven duodenal ulcers. The pangastritis involving the whole stomach, now ulcer and gastric cancer, and the third with neither ulcers nor usually with symptoms. known to be caused by H. pylori, was well described by Correa and Stemmerman and Hayashi. It is referred to The gastritis pattern associated with duodenal ulcer can probably be recognized relatively easily by examining by the acronym MAG for multifocal atrophic gastritis. I three large, well-placed endoscopic biopsy specimens believe that MAG should be subdivided and would be (two from the lesser curvature of the antrum and one better replaced by two new acronyms representing diffrom the mid–greater curvature of the gastric body). The ferent clinicopathologic subsets: nonulcer pangastritis acronym for this type of gastritis is DAG for diffuse (NUP), found in usually asymptomatic H. pylori–infected antral-predominant gastritis. Inflammation of the pyloric individuals without ulcers, and progressive intestinalized glands of the antrum is diffuse and will be of similar pangastritis (PIP), found in patients with non–nonsteroiseverity in both antral biopsy specimens. Although focal dal anti-inflammatory drug (non-NSAID) gastric ulcers intestinal metaplasia may be present in the antrum of and distal gastric cancers. 10%–20% patients with duodenal ulcer, it is less severe The acronym NUP is proposed for the type of gastritis and far less extensive than that seen in patients with seen in more than 90% of usually asymptomatic individgastric ulcer. On the other hand, inflammation of the uals infected with H. pylori who do not have an ulcer. fundal glands is mild or absent in DAG despite histologiThis entity has not been studied extensively because it cally demonstrable H. pylori infection. Intestinal metais difficult to justify endoscopy with extensive biopsy in plasia of the fundal glands is never seen in DAG. Beasymptomatic individuals. However, it has been well cause extensive intestinal metaplasia is the most accepted Abbreviations used in this paper: DAG, diffuse antral-predominant possible precursor of distal gastric cancer, it is not surgastritis; MAG, multifocal atrophic gastritis; NUP, nonulcer pangasprising that the gastric cancer risk is low in patients tritis; PIP, progressive intestinalized pangastritis. with duodenal ulcer disease. Similarly, increased acid q 1997 by the American Gastroenterological Association 0016-5085/97/$3.00 secretion in duodenal ulcer is to be expected with its