Gastroenterology
H. pylori Gastritis
H.파일로리위염
Chronic gastritis from spiral gram-negative H. pylori
- How common
- Korean adults 50–60%
- Typical age
- All ages (childhood acquisition)
What is it?
H. pylori uses urease to neutralize acid, colonizes beneath mucus layer causing chronic inflammation, predisposes to ulcer, cancer, MALT lymphoma.
Commonly affected: Gastric antrum predominant, body involved later
How it develops
- Oral/fecal acquisitionChildhood familial transmission
- Mucus colonizationFlagella penetrate and adhere to mucus layer
- Urease secretionUrea → ammonia neutralizes acid
- Chronic inflammation/atrophyGastritis → atrophy → intestinal metaplasia → dysplasia → cancer
Symptoms
- Epigastric discomfortNon-specific dull pain
- Dyspepsia/bloatingPostprandial fullness
- Nausea/belchingFrequent eructation
- AnorexiaMild weight loss
- AsymptomaticMany remain asymptomatic
How it is examined
- Non-invasive testsUrea breath test, stool antigen test
- EGD + biopsyCLO test, histology, culture
- SerologyIgG antibody (cannot distinguish past infection)
Imaging
Not diagnostic; for complications.
- Clinical
EGD directly visualizes gastritis, atrophy, metaplasia.
- Antral nodular gastritis
- Atrophic gastritis
- Intestinal metaplasia
Non-surgical care
- Standard triple therapy (7–14d)PPI + clarithromycin 500mg + amoxicillin 1g BID
- Bismuth quadruple therapyPPI + bismuth + metronidazole + tetracycline (resistance/older)
- Sequential therapy5d PPI+amoxi → 5d PPI+clari+metro
- Concomitant therapyPPI + amoxi + clari + metro for 14 days
- Test of cureUBT or stool antigen 4 wks after therapy
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Complications (perforation, bleeding, malignancy)
Procedures that may be discussed
- Emergency gastric repair
- Gastrectomy for malignant change
- Endoscopic hemostasis
Outlook
Eradication reduces gastric cancer risk 30–50%; MALT lymphoma remits in >70%.