PATHOLOGY, PATHOPHYSIOLOGY, AND DIAGNOSIS OF HELICOBACTER HEILMANNII INFEDTION

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Gastric biopsy materials of 4074 consecutive Japanese patients undergoing esophagogastroduodenoscopy were reviewed, along with those of 15 patients with Helicobacter heilmannii (H.heilmannii) infection (1, chronic gastritis ; four, mucosa-associated lymphoid tissue (MALT) lymphoma]. The prevalence of H.heilmannii was 0.1% in the consecutive series. In chronic gastritis, the gastric mucosa was endoscopically normal (13.3%), had erythema (33.3%), or had erosions (53.3%) ; histologically, it showed no epithelial change, mild mononuclear cell infiltration, and slight and focal neutrophil infiltration. H.heilmannll was positive with anti-H.pylori antibody, and was detected in the mucous gel layer and in foveolae. In contrast, the serum and urinary antibody tests for H.pylori infection produced negative results in patients with H.heilmannii infection, suggesting the presence of relatively specific antigens in H.heilmannii : Eradication of H.heilmannii resulted in remission of MALT lymphoma. … More H.heilmannii infection is uncommon in Japanese adults, but is associated with chronic gastritis and gastric MALT lymphoma. A Mongolian gerbil model exhibited a high incidence of gastric MALT lymphoma-like lesion by H.heilmannii, whereas a Mongolian gerbil model of H.pylori infection exhibited hyperplastic polyps and ulcers. In Mongolian gerbils with H.pylori infection, high levels of mucosal IL-1β mRNA were observed early in the infection, reaching maximum at 4 weeks and then rapidly declining. Mucosal IFN-γ mRNA also reached maximal levels at 4 weeks but remained high there after. Both IL-1β and IFN-γ mRNA levels were consistently higher in the pyloric mucosa than in the fundic mucosa. In contrast, IL-4, IL-6, and IL-10 mRNA levels peaked at 8 to 26 weeks and levels were similar in the pyloric mucosa and the fundic mucosa. IFN-γ mRNA levels were significantly higher in gerbils with ulcers than in those with hyperplastic polyps. The different outcomes (e.g., ulcers or hyperplastic polyps) might relate to imbalances among cytokines. In Mongolian gerbils, loss of the virD4 gene in H.pylori temporally retarded but did not abrogate gastric inflammation, and loss of the cage gene in H.pylori abolished gastric inflammation partially via reduced ability to colonize. Unknown factors related to the type IV secretion system other than CagA may influence gastric inflammation. Less