The patient is a 55 year-old woman who presented with dyspepsia. Evaluation was performed with upper endoscopy.
After entering the stomach, subtle mucosal abnormalities were seen in the gastric antrum. Specifically, there was mild, patchy erythema and congestion, as well as granularity and nodularity.
On retroflexion, the incisura as well as the rugal folds appeared normal. There was no evidence of peptic ulcer disease.
Similarly, the duodenal bulb and second portion of the duodenum were normal.
Biopsies proved the antral mucosal abnormalities to be due to Helicobacter pylori.
H. pylori gastritis is one of the causes of dyspepsia. On endoscopy, the diagnosis is suspected with characteristic signs of erythema, most often located in the antrum. Additionally, the mucosa can appear granular, nodular, or can even have a cobblestone pattern.
Diagnosis can be made with biopsy and CLO testing for urease production. As seen here, when tissue with urease-producing H. pylori is added to a urea-rich medium, the phenol indicator turns red. In comparison, if the tissue is H. pylori negative, the medium remains yellow.
An alternative diagnostic strategy is to perform gastric biopsy and histopathologic examination. This is an H&E stained section of gastric mucosa at 400x magnification. Numerous H. pylori organisms can be seen adherent to the mucosal surface.
In summary, H. pylori gastritis is a cause of dyspepsia. It is visually suspected on endoscopy, and can be confirmed with either CLO testing or demonstration of the organisms on gastric biopsy.
Evan S. Dellon, MD, University of North Carolina
John Woosley, MD, PhD, University of North Carolina
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital
Brenna C. Bounds, M.D., Harvard Medical School, Massachusetts General Hospital
Gottumukkala S. Raju, MD, MD Anderson Cancer Center