Journal of Gastrointestinal & Roland et al.

, J Gastrointest Dig Syst 2016, 6:1

Digestive System DOI: 10.4172/2161-069X.1000392

Prevalence and Associated Risk

Factors of Helicobacter pylori
Negative Gastritis

Journal Presentation By Hasbiallah Yusuf, M.D.

 IDENTITY OF THE PRESENTATOR

Full Name : Hasbiallah Yusuf, M.D.

Date and Place of Birth : Banda Aceh, October 7th 1990
Address : EH-14, Poligon, Bukit Sejahtera
Residence, Bukit Lama, Ilir Barat 1,
Palembang, South Sumatra
Religion : Islam
Hobby : Traditional and Digital Fine Art
Graduated from : Faculty of Medicine, University of
Sriwijaya, 2015
 BACKGROUND

Previously thought to
Helicobacter pylori account for nearly
(Hp) infection all chronic gastritis

Hp-negative gastritis is common and incresing in prevalence in USA

Recent studies
The etiology and associated risk factors for Hp-negative gastritis
remain uncertain
 OBJECTIVE

Primary Aims

Characterize differences and

similarities in : associated
Assess the prevalence of Hp-
demographics, clinical features,
negative gastritis
risk factors and medical co-
morbidities

Between Hp-negative and

Hp-positive gastritis
 METHODS
Retrospective Study

Dysphagia Who were referred for

EGD (Esophagogastro-
Records of 131 duodenoscopy) at a
Abdominal pain
consecutive single tertiary care
patients center for biopsies
Nausea/vomiting

Gastrointestinal
Iron deficiency anemia
symptoms
Clinical, demographic, and
Bloating laboratory data were
compared between
one-year Belching individuals with Hp-negative
period from and Hp-positive gastritis
7/2012 to
7/2013 Barrett’s esophagus
 METHODS
Antrum
EGD
Corpus

The presence of gastritis,

placed in two separate ulceration, erosions and
biopsy containers. other lesions was also
derived from the
endoscopy report

Diff-Quik staining method was used as the standardized

Histopathology, serology,
method for all the cases of H. pylori . Biopsies were taken
cultures
from the mid antrum and the greater curvature of mid corpus
 RESULTS
Records of 131 consecutive
patients were reviewed

Among all 131 patients surveyed :

50 (38.2%) had gastritis present on biopsy

Hp-negative : Hp-positive :
39 patients (78.0%) 11 patients (22.0%)
RESULTS
RESULTS
RESULTS
RESULTS
RESULTS
RESULTS
 DISCUSSION
 Hp-negative gastritis comprised the majority (78.0%) at our institution.
 Much common in Caucasians (61.5%) than in other races, particularly African-
Americans (20.5%)  Prior studies : prevalence in Caucasians (70.7%) vs.
African-Americans (26.8%).
 The true prevalence is unknown.
 Decreasing rate in developed countries contributes to associated factors : PPI’s,
alcohol, tobacco, IBD, celiac disease, autoimmune gastritis, a small portion of
missing bacteria (sampling error), and infection with other species including H.
heilmannii, Streptococcus and Prevotella.
 Prior studies have highlighted a significant association with PPI, NSAID, alcohol,
and tobacco use  We found no association with this specific risk factor.
 DISCUSSION
 Hp-negative infection was significantly associated with the presence of medical
co-morbidities, especially GERD (66.7%)  likely to be on PPI treatment.
 With Hp eradication, Hp-positive gastritis patients exhibit worsening of GERD
symptoms, except antrum-dominant gastritis (show improvement)  Exact
mechanism is unclear, role of local inflammation and cytokines, such as tumor
necrosis factor alpha and interleukin-1-beta.
 Hp infection enhances the acid suppression by PPI therapy  Hp infection may
even be protective against development of GERD  remains and needs to be
further explored.
 Hp-negative gastritis was mild, focal, and chronic; Hp-positive gastritis was
chronic-active or active.
 Chemical gastritis (61.5%), not associated with Hp infection, may now be the
predominant forms in USA  GERD is the most significant factors.
 DISCUSSION
 The clinical relevance and prognosis of Hp-negative gastritis remain unknown.
 In clinical practice, routine treatment with PPI or H2 blockers is not advised.
 Limitations of our study include the characteristics inherent to retrospective
studies including imperfect control of bias and confounding variables. Also, as it
was retrospective the biopsy procedure was not in accordance with the updated
Sydney System requiring at least five specimens, and there was only one
pathologist for review.
 CONCLUSION

 Hp-negative gastritis was characterized by the tendency to affect antrum

 78.0% of all gastritis at this institution.
 Caucasian race and comorbidity of GERD were significantly associated,
while notably PPI, NSAID, alcohol, and tobacco use were not.
 Hp infection may provide protection against GERD through unclear
mechanisms.
 This study provides implications for screening and management for
appropriate population with Hp-negative gastritis.
 Prospective studies are needed to further delineate the natural etiology,
risk factors, prognosis of this poorly understood and increasing clinical
entity, as well as possible association with GERD and Hp infection
Thank You for the Attention