Helicobacter Forums

Hi, I got the biopsy report, but I have an appointment with my GI in two weeks. Could You please write if there is cause for concern because of the part where intestinal metaplasia is mentioned?

Samples of antral gastric mucosa, preserved epithelium, foveolar cells twisted and elongated, lined with cylindrical cells of light cytoplasm, basal placed nucleus. The glands are the antral type, in a continuous layer. The lamina propria shows inflammation comprising of lymphocytes, plasma cells, and rare eosinophilic granulocytes. Incomplete intestinal metaplasia is present in less than 25% of the foveolar cells. Helicobacter pylori is present focally in small numbers.
Inflammation -1, Atrophy-0, Activity - 0, Intestinal metaplasia - 1, HLO - 1.

A sample of the corpus gastric mucosa with regular foveolar cells. The lamina propria of the foveolar layer contains infiltrates of lymphocytes, plasma cells, and rare eosinophilic granulocytes. Intestinal metaplasia is not present. Helicobacter pylori is present focally in small numbers.
Inflammation -1, Atrophy - 0, Activity - 0, Intestinal metaplasia - 0, HLO - 1. Epithelial dysplasia is not present.

Dg; Chronic gasritis (H.Plyori +)

I think most importantly is H. pylori detected.
So your best strategy is to get rid of H. pylori.

If you are young, got rid of H. pylori, and the intestinal metaplasia is mild, the intestinal metaplasia can be reversible.

Helico_expert wrote: ↑

Sat Apr 17, 2021 10:01 am

I think most importantly is H. pylori detected.
So your best strategy is to get rid of H. pylori.

If you are young, got rid of H. pylori, and the intestinal metaplasia is mild, the intestinal metaplasia can be reversible.

I'm 30 years old. Does info about intestinal metaplasia in less than 25% foveolar cells, and only in antrum (corpus is intact) indicates that IM is mild? How is it possible that I've developed even mild IM when there's only few neutrophils and small numbers of HP as the main indicator of gastritis severity. I don't get it. It's emphasized in my biopsy report: Inflammation 1 and Activity 0 score. It is so confusing to me.

And what about the small H.pylori density? Does this mean that eradication rate is higher and that antibiotics could kill the bacteria more easily than in case when there is overgrowth of H.pylori?

the biopsy taken only represent a very small part of your stomach. So we dont know for sure how severe is your IM.

H. pylori only colonise in healthy stomach. So it is normal to see little H. pylori in a biopsy sample that has IM.

30 years old is consider young. So dont worry too much about it. Have your doctor prescribed you antibiotics and a follow up plan?

Helico_expert wrote: ↑

Mon Apr 19, 2021 8:02 am

the biopsy taken only represent a very small part of your stomach. So we dont know for sure how severe is your IM.

H. pylori only colonise in healthy stomach. So it is normal to see little H. pylori in a biopsy sample that has IM.

30 years old is consider young. So dont worry too much about it. Have your doctor prescribed you antibiotics and a follow up plan?

No, he said there's no need for antibiotics since there's no activity, atrophy, severe IM and H.Pylori density is very low. Follow up plan: another endoscopy in 10 years.

hmmm... i dont agree with your doctor. It may be too late when you have symptoms. Perhaps you want to seek second opinion on this.

I wonder how is it possible to have H.Pylori (even low density) and inactive chronic gastritis at the same time? Also, visual endoscopy and histological report didn't find any abnormalities.

inactive gastritis is an actual term used in histology. Usually when H. pylori is gone, the immune cells remains but inactive.

to date, because of the heavy workload, if the pathologist saw a histology slide that has inactive inflammation, he would immediately claim it as HP negative without further investigation. It is about 98% accurate.

what abnormality would trigger you to get a treatment?
or perhaps you can prevent abnormality by taking a treatment now.

Do not know, it is in the biopsy report, plasma cells, lymphocytes and few eosinophils are present but no neutrophils detected, so it has zero activity score. Didn't took any PPI one month prior to endoscopy. Low density H.Pylori detected. Could this be the case with coccoid form or false positive? Here's an example - https://pubmed.ncbi.nlm.nih.gov/12428792/

This study shows positive neutrophil activity in all H.Pylori positive patients. No case with zero activity in H.Pylori positive patients. I'm still confused that my biopsy report shows no neutrophil activity and H.Pylori +.

https://pathology.medresearch.in/index. ... ew/273/542

not sure about the cocoid form.
histology is only examining a very very small part of your stomach.
the good news is that endoscopy did not see any abnormality. So the chance of healing is high.

maybe you need breath/stool test to confirm if you still have H. pylori.