- What is the diagnosis?
This is chronic non-specific gastritis. There is no ulceration.
- What are the organisms seen above the mucosa?
These are Helicobacter pylori organisms. They are short curved to S-shaped rods that can be barely seen with H&E stains, and better seen with Giemsa or silver stains. H. pylori organisms are non-invasive, living in the gastric mucus above the mucosa. Somehow, they create an environment in which chronic gastritis, as well as peptic ulcer disease, are more likely. The incidence of H. pylori infection increases with age and is higher in developing nations.
- What is the prognosis?
The gastritis itself is not life-threatening and can be treated with pharmacologic agents that are aimed at eliminating the H. pylori. "Triple therapy" with tetracycline-metronidazole-bismuth, or other combinations of antibiotics (amoxicillin-clarithromycin), along with a proton pump inhibitor such as omeprazole, can fulfill this purpose. The long-term benefit for this therapy is a reduction in the risk for gastric carcinomas and lymphomas. In fact, the mucosa-associated lymphoid tissue (MALT) lymphomas arise in the setting of H. pylori infection and will regress when these organisms are eliminated.
- What pharmacologic agent(s) can have a similar effect?
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and aspirin can produce gastropathy, chronic gastritis, and ulceration in stomach and duodenum. The gross and microscopic appearances are similar to the lesions caused by H. pylori. The mechanisms by which aspirin and NSAIDs produce gastrointestinal problems are poorly understood and may arise from several causes, including removal of the protectant effect of endogenous prostaglandins by inhibition of cyclo-oxygenase I, and manifested by direct and indirect mucosal injury, exacerbation of underlying peptic ulcer disease, exacerbation of H. pylori gastritis, and motility disorders.
