Background: We have recently observed a number of patients from Colombia with a distinctive endoscopic lesion characterized by multiple gastric hemorrhagic lesions, predominantly in the fundus, in the absence of known predisposing conditions, such as physiological stress, portal hypertension, or chemical injury (alcohol, NSAIDS), which are usually associated with acute hemorrhagic gastritis. Objectives: 1) to define the correlation between the endoscopic appearance and the histopathological characteristics of the gastric mucosa in these patients; 2) to explore its possible association with Helicobacter pylori infection; 3) to evaluate the effects of anti-H. pylori treatment. Patients and Methods: Fifty-two patients (35 women and 17 men, age range 21-84 years) with no predisposing factors were included in the study. Endoscopic findings were characterized by multiple, patchy, flat, 1-4 mm in size, occasionally coalescent, submucosal hemorrhagic lesions predominantly distributed in the fundus near the lesser curvature. The endoscopic appearance was graded on a four-grade scale of progressive severity. Multiple gastric biopsy specimens were obtained from each patient at the time of the original diagnosis, stained with the Genta stain, and evaluated for localization and extension of hemorrhage, type of inflammation, intestinal metaplasia, atrophy, erosions, necrosis, and presence of H. pylori based on a semi-quantitative visual analogue scale. All patients received therapy for H. pylori. Follow-up biopsies were obtained in thirty-two patients. Results: The initial biopsies showed H. pylori infection in 45 of the 52 patients (86%). Subepithelial hemorrhage of grade 2 (with extension to the periglandular lamina propria) or greater was observed in 28 (73%) patients. Follow-up biopsies showed cure of H. pylori in 25 of 30 previously positive patients (86%). In 16 (64%) of these patients the post-treatment endoscopic score improved by 2 grades or more, in 8 (32%) it improved by 1 grade and in the remaining patient it remained unchanged. Histologically, cure of H. pylori resulted in the disappearance of active gastritis, but no significant change of the mucosal hemorrhage was detected. Conclusions: The strong association of hemorrhagic gastropathy with H. pylori infection and the significant endoscopic improvement obtained after cure of H. pylori suggest a possible casual relationship between these two entities. However, the apparent lack of correlation between endoscopic and histopathological findings indicate that further studies are required to document a cause-effect relationship.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging