Helicobacter pylori gastritis

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Clinical history: 26 year-old male with no significant past medical history presents with persistent vague abdominal pain

Site: Stomach

Histology:

Antral-type gastric mucosa showing increased chronic inflammation in the lamina propria consisting predominantly of lymphocytes and plasma cells. The inflammation is greater near the surface than the base of the mucosa.
Increased plasma cells in the lamina propria. Several mitoses are seen in the bases of crypts as a reparative response to the inflammation.
Helicobacter pylori organisms seen in surface epithelium on H&E stain
Helicobacter pylori organisms seen in deeper crypts on H. pylori immunohistochemical stain

Diagnosis: Helicobacter pylori gastritis

Diagnostic notes: It’s important to distinguish Helicobacter pylori gastritis from autoimmune metaplastic atrophic gastritis (AMAG) which both present with increased chronic inflammation. AMAG shows increased chronic inflammation, predominantly in the base of the mucosa, as well as loss of oxyntic glands, intestinal metaplasia, pancreatic acinar cell metaplasia, and ECL-cell hyperplasia. Intestinal metaplasia can also occur in H. pylori gastritis.

Every gastric biopsy needs to include a comment:
+/- Helicobacter organisms
+/- Intestinal metaplasia (if yes, +/- dysplasia)

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