Helicobacter Carditis and Its Association with Symptoms, EGD Findings and Coexistent Helicobacter Gastritis, Helicobacter Duodenitis, Gastroesophageal Reflux and Barrett's Esophagus
Ihab Lamzabi, Richa Jain, Shriram Jakate. Rush University Medical Center, Chicago, IL
Background: During esophagogastroduodenoscopy (EGD), it is common to obtain random or targeted biopsies from all 3 sites - distal esophagus, stomach and duodenum for a wide variety of symptoms such as pyrosis, dysphagia, dyspepsia, abdominal pain, anemia and weight loss. Such biopsies may also be performed in asymptomatic patients undergoing screening for Barrett's or varices. Occasionally, the GE junction biopsies show clinically unanticipated Helicobacter pylori (HP) carditis. We studied the association of this pathological finding with symptoms, EGD features and concomitant histological Helicobacter gastritis, Helicobacter duodenitis, gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE).
Design: Between January 2008 and August 2012, 3962 EGDs were performed in our Medical Center where biopsies from 3 sites - distal esophagus or GE junction, stomach and duodenum were simultaneously obtained either randomly or targeted toward endoscopic abnormalities. 54 cases (1%) showed Helicobacter organisms and moderate or severe inflammation of the cardia at GEJ. The clinical, endoscopic and histological features of these cases were reviewed.
Results: HP carditis was not specifically associated with any particular symptom although symptomatic patients (92%) far outnumbered asymptomatic patients (8%). Certain symptoms such as pyrosis (29%), abdominal pain (18%), dysphagia and anemia (12% each) were most frequent. Endoscopically, GEJ was described as normal (46%), nonspecific and/or reflux esophagitis (40%), ulcerated (5%) or irregular Z line with questionable short Barrett's segment (9%). All cases (100%) showed coexistent moderate to severe Helicobacter gastritis. Helicobacter duodenitis was present in only 6/54 (10%) cases. Coexistent GERD was present in 26/54 (48%) cases and BE was rare and seen in only one case.
Conclusions: HP carditis is not selectively associated with any specific symptom or endoscopic finding and nearly half the patients may have normal-looking GEJ. Symptom of pyrosis and esophagitis on EGD are likely due to frequent association with GERD. Coexistent Helicobacter gastritis is universally present in 100% of patients but concomitant Helicobacter duodenitis is uncommon. Association of BE with HP carditis is extremely rare and correlates well with aversion of Helicobacter organisms to goblet cell metaplasia.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 74, Wednesday Afternoon