H pylori

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  • Histology

    • chronic active gastritis (lymphoplasmacytic inflammation and PMNs)
      • chronic = lymphoplasmacytic in superficial mucosa. Lymphoid aggregates and follicles.
      • active = PMNs in gastric pits
    • foveolar hyperplasia
    • mucosal degeneration, and erosion if severe
    • organisms can be seen on high power
  • Other Manifestations

    • acute infection: rarely biopsied
    • chronic inactive gastritis: past infection, plasma cells without PMNs
    • lymphocytic and follicular gastritis: follicles are highly specific for H pylori
    • granulomatous gastritis
    • hyperplastic polyp
    • environmental atrophic metaplastic gastritis: multifocal intestinal metaplasia
  • Ddx

  • Stains

    • Silver stains: Warthin-Starry, Genta stain
    • H pylori IHC stain