Hemorrhagic gastropathy: Possible relationship with Helicobacter pylori infection
Background: We have recently observed a number of patients from Colombia with a distinctive endoscopic appearance characterized by multiple gastric hemorrhagic lesions occuring predominantly in the fundus, and in the absence of known predisposing conditions, such as physiological stress, portal hypertension, or chemical injury (e.g., alcohol, NSAIDs). Objectives: To define the correlation between the endoscopic appearance and histopathological characteristics of the gastric mucosa in these patients and To explore its possible association with Helicobacter pylori (Hp) infection. Patients and Methods: Fifty-two adults with no predisposing factors were included. Endoscopic findings were characterized by multiple, patchy, flat, 1-4 mm, occasionally coalescent, mucosal hemorrhagic lesions predominantly in the fundus near the lesser curvature. Gastric biopsies were evaluated for localization and extension of hemorrhage, type of inflammation, and presence of Hp. All patients received therapy for Hp. Short term follow-up was obtained in 32 patients. Eight patients were reexamined after 12 to 20 months. Results: The initial biopsies showed Hp infection in 45 of the 52 patients (86%). Subepithelial hemorrhage was observed in 28 patients (73%). Follow-up biopsies showed cure of Hp in 25 of 30 previously positive patients (86%). In 16 (64%) of the 25 cured patients the post-treatment endoscopic score (scale 0 to 4) improved by 2 grades or more. In 8 (32%). It improved by 1 grade and in one patient remained unchanged. Histologically, cure of Hp resulted in the disappearance of active gastritis, but no significant change of the mucosal hemorrhage was detected. Six of 8 patients examined at endoscopy after one year of therapy had normal gastric mucosa (resolution of the hemorrhagic lesions), 1 improved and 1 had no change in the endoscopic appearance. Conclusions: The association of hemorrhagic gastropathy with Hp infection and the significant endoscopic improvement obtained after cure of Hp infections suggests a possible causal relationship between these two entities. Typical lesions can remain apparent for up to one year after cure of the Hp infection.
Gutierrez, O., Segura, A., Cabrera, M., Sepulveda, A., Genta, R., & Graham, D. (1997). Hemorrhagic gastropathy: Possible relationship with Helicobacter pylori infection. Gastrointestinal Endoscopy, 45 (4). http://dx.doi.org/10.1016/S0016-5107(97)80267-2