Helicobacter pylori may cause "reflux" gastritis after gastrectomy

Management of Helicobacter pylori infection after gastric surgery

The Maastricht IV/Florence Consensus Report and the Second Asia-Pacific Consensus Guidelines strongly recommend eradication of Helicobacter pylori (H. pylori) in patients with previous gastric neoplasia who have undergone gastric surgery. However, the guidelines do not mention optimal timing, eradication regimens, diagnostic tools, and follow-up strategies for patients undergoing gastrectomy and do not indicate if eradication of H. pylori reduces the risk of marginal ulcer or stump cancer in the residual stomach after gastrectomy. The purpose of this review is to provide an update which may help physicians to properly manage H. pylori infection in patients who have undergone gastric surgery. This review focuses on (1) the microenvironment change in the stomach after gastrectomy; (2) the phenomenon of spontaneous clearance of H. pylori after gastrectomy; (3) the effects of H. pylori on gastric atrophy and intestinal metaplasia after gastrectomy; (4) incidence and clinical features of ulcers developing after gastrectomy; (5) does eradication of H. pylori reduce the risk of gastric stump cancer in the residual stomach? (6) does eradication of H. pylori reduce the risk of secondary metachronous gastric cancer in the residual stomach? and (7) optimal timing and regimens for H. pylori eradication, diagnostic tools and follow-up strategies for patients undergoing gastrectomy.

Unusual Helicobacter pylori in gastric resection specimens: an old friend with a new look

Immunohistochemical staining is useful in the diagnosis of Helicobacter pylori-induced gastritis. The authors encountered gastric resection specimens with an unusual pattern of reactivity on H pylori immunostains where the typical morphology of the organism was not recognizable, but the characteristic chronic gastritis associated with infection was present. The authors sought to explore this phenomenon by retrospectively reviewing and immunostaining 28 gastric resection specimens for H pylori. Six cases with large clumps of immunohistochemically positive but morphologically unrecognizable material were identified on light microscopy, corresponding on electron microscopy to clusters of predominantly coccoid H pylori, some located intracellularly. Such organisms were not identifiable without immunohistochemistry, and the phenomenon was not encountered in gastric biopsies. The authors conclude that this staining pattern reflects true H pylori infection that is not diagnosable without immunohistochemistry. Based on its occurrence only in resections, it may be the result of hypoxic or other stress induced when the mucosa is not promptly fixed.