H. PYLORI NEGATIVE GASTRITIS: A TIP OF THE ICEBERG

Introduction: Worldwide common cause of gastritis is H. pylori infection. Treatment of H. pylori infection results in rapid disappearance of polymorphonuclear infiltration, reduction in lymphocytes and gradual normalization of mucosa. Mucosal atrophy and metaplastic changes resolve slowly. A recent study of patients with erosive esophagitis reported that 75 - 90 % of H. pylori- negative subjects had gastritis. Similarly, 56– 69% of H. pylori -negative subjects with dyspepsia or nonerosive gastroesophageal reflux had gastritis. Identifiable risk factors for H. pylori –negative gastritis are alcoholism, smoking, intake of proton pump inhibitors (PPI) and spicy diet. Aims: To find out prevalence and risk factors for non H.pylori gastritis. Materials and methods: Fifty four patients with dyspepsia, were evaluated with endoscopy and biopsy. Biopsies were taken from different areas and were studied for activity in mucosa, chronic inflammation, atrophy of glands, intestinal metaplasia and presence of H.pylori and were graded according to Updated Sydney System. Giemsa stain and Serum IgG anti H.pylori antibodies helped to confirm H. pylori negative gastritis. Results: Out of 54 cases, 33 (61.11%) were H.pylori negative gastritis. All 33 cases presented with dyspepsia and 21 (63.63%) had GERD. On endoscopy, 21 (63.63%) cases showed pangastritis and 2 had ulcer. All patients of GERD were on PPI. On histopathology, 8 (24.24%) cases showed chronic active inflammation, 3(9.09%) had mucosal atrophy and 6 (18.18%) showed intestinal metaplasia. Conclusion: H. pylori- negative gastritis accounted for 61.11%. Common risk factor for H. pylori- negative gastritis is intake of PPI. As H. pylori- negative gastritis incidence is significant, further studies have to be conducted to identify risk factors.