Clinical aspects of Helicobacter heilmannii-associated gastritis in patients with dyspepsia: A systematic review and meta-analysis

Helicobacter heilmannii Infection With Concurrent Gastric Cancer: A Case Report

Helicobacter heilmannii (H. heilmannii), a zoonotic pathogen, is increasingly recognized as a cause of gastritis and a potential risk factor for gastric cancer, despite its rarity. Here, we report a case of multiple synchronous early gastric cancers in a female patient in her 40s with H. heilmannii-associated gastritis. She underwent an esophagogastroduodenoscopy (EGD) for the evaluation of gastric discomfort. Endoscopy revealed cobblestone-like gastritis. Histological examination confirmed a signet ring cell carcinoma. Helicobacter pylori (H. pylori) antibody test was negative, and spiral-shaped bacteria were detected by Giemsa staining and real-time polymerase chain reaction (PCR), confirming H. heilmannii infection. Endoscopic submucosal dissection achieved curative resection without recurrence. Helicobacter heilmannii-induced gastritis presents distinct features, including a cobblestone-like appearance and lymphocyte-dominant infiltration, differing from H. pylori-associated gastritis. Chronic inflammation and immune modulation caused by H. heilmannii infection may contribute to carcinogenesis. Considering the diagnostic challenges and zoonotic transmission risks, enhanced awareness of H. heilmannii-associated gastric cancer is essential. This case highlights the importance of identifying H. heilmannii in H. pylori-negative gastritis and its potential role in gastric carcinogenesis. Further research is required to elucidate the pathogenic mechanisms and establish effective management protocols.

Clinical presentation and outcomes of Helicobacter heilmannii gastritis in children in the New England region of the United States

OBJECTIVE

To describe the clinical, endoscopic, histologic, and treatment outcomes of Helicobacter heilmannii (H. heilmannii) associated gastritis in children in the New England region of the United States.

METHODS

Retrospective study of children (1-18 years) with H. heilmannii identified on gastric mucosal biopsies from two pediatric centers over a 21-year period, January 2000-December 2021. Cases were identified by querying pathology databases at each institution. Demographic and clinical data were obtained from the medical record. Endoscopic and histologic findings were extracted from endoscopy and pathology reports, respectively.

RESULTS

Thirty-eight children were diagnosed with H. heilmannii-associated gastritis during the study period. The mean age at diagnosis was 10.1 ± 5.3 years, and 25/38 (66%) cases were male. Abdominal pain (32%) and nausea with or without vomiting (26%) were the most common symptoms. Thirty-two children (84%) had endoscopic findings including gastric nodularity (55%) and erythema (26%). All children had histologic signs of chronic gastritis, including those with normal endoscopic exams. Antibiotic regimens used for treating Helicobacter pylori were frequently prescribed. Of the 17 children who underwent a follow-up endoscopy (range 2-68 months), 15 (88%) did not have H. heilmannii identified on gastric biopsies.

CONCLUSION

H. heilmannii was an infrequent but potential cause of epigastric abdominal pain and nausea in our cohort of New England children. While morphologically distinct from H. pylori, the bacteria can result in similar endoscopic and histologic findings of nodularity and chronic gastritis, respectively. The rate of eradication, as assessed by histology following treatment with H. pylori therapies, was below the 90% recommended goal for antimicrobial therapies.

Role of non-Helicobacter pylori gastric Helicobacters in helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma

Marginal zone lymphomas rank as the third most prevalent form of non-Hodgkin B-cell lymphoma, trailing behind diffuse large B-cell lymphoma and follicular lymphoma. Gastric mucosa-associated lymphoid tissue lymphoma (GML) is a low-grade B-cell neoplasia frequently correlated with Helicobacter pylori (H. pylori)-induced chronic gastritis. On the other hand, a specific subset of individuals diagnosed with GML does not exhibit H. pylori infection. In contrast to its H. pylori-positive counterpart, it was previously believed that H. pylori-negative GML was less likely to respond to antimicrobial therapy. Despite this, surprisingly, in-creasing evidence supports that a considerable proportion of patients with H. pylori-negative GML show complete histopathological remission after bacterial eradication therapy. Nonetheless, the precise mechanisms underlying this treatment responsiveness are not yet fully comprehended. In recent years, there has been growing interest in investigating the role of non-H. pylori gastric helicobacters (NHPHs) in the pathogenesis of H. pylori-negative GML. However, additional research is required to establish the causal relationship between NHPHs and GML. In this minireview, we examined the current understanding and proposed prospects on the involvement of NHPHs in H. pylori-negative GML, as well as their potential response to bacterial eradication therapy.