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ABDOMINAL RADIOLOGY Table of Contents   
Year : 2000  |  Volume : 10  |  Issue : 4  |  Page : 247-248
Helicobacter pylori gastritis: A sonographic mimic of gastric neoplasm


1 Dept of Radiology, India
2 Dept of Gastroenterology, India
3 Dept of Surgery, India

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Keywords: H. pylori, gastritis, ultrasound

How to cite this article:
Gothi R, Sud R, Ray A. Helicobacter pylori gastritis: A sonographic mimic of gastric neoplasm. Indian J Radiol Imaging 2000;10:247-8

How to cite this URL:
Gothi R, Sud R, Ray A. Helicobacter pylori gastritis: A sonographic mimic of gastric neoplasm. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Jun 20];10:247-8. Available from: http://www.ijri.org/text.asp?2000/10/4/247/30573

   Case report Top


A seventy-two-years old male, a chronic smoker, was sent for ultrasound of the upper abdomen with complaints of abdominal pain and loss of appetite for the past two to three months. A transabdominal ultrasound was performed with a 3.7 mHZ multifrequency probe (Ecocee,Toshiba, Japan). The ultrasound revealed a predominantly intraluminal antral lesion, involving the stomach wall circumferentially with resultant luminal narrowing [Figure - 1],[Figure 2]. It was 9 mm thick and the texture of the affected area, heterogeneous. There was no perigastric extension, nodes or liver metastasis.

The patient was administered water to distend the stomach. The pylorus remained contracted while the rest of the stomach showed adequate distension and appeared normal. In view of the localized circumferential thickening in the pyloric region, loss of appetite and pain, a possibility of gastric malignancy was suspected and endoscopy requested.

Endoscopy revealed a marked rugal thickening in the pyloric antrum with gastric and duodenal ulcers. The appearance was suggestive of antral gastritis with benign ulcers. A biopsy revealed inflammatory cells in the mucosa and submucosa and H. pylori infection. There was no evidence of any malignancy.

Appropriate therapy was instituted with complete resolution of the clinical symptoms as well as the ultrasound findings.


   Discussion Top


H pylori infection is a significant agent in the development of chronic gastritis and benign gastric and of chronic gastritis and benign gastric and duodenal ulcers [1],[2],[3]. It is found in all races, increases in incidence with age [3] and may occur in asymptomatic individuals too [4].

The infection predominantly affects the pyloric antrum where it produces thickened gastric folds. Duodenal bulb abnormalities also have a high positive association with H. pylori infection. The disease can be suspected on barium studies when thickened gastric mucosal folds are found in the antral region [5].

Little has been mentioned about the role of ultrasound in the diagnosis of H. pylori infection. USG, which is often the initial investigation in a case of abdominal pain and loss of appetite, may reveal a thickened pylorus with altered texture and luminal narrowing. This may lead to an erroneous diagnosis of gastric malignancy and put the patient to unnecessary inconvenience. H. pylori infection is much more common than malignancies.

It is, therefore, important for a sonologist to remember this condition as an important cause of predominantly intraluminal pyloric thickening and include it in the differential diagnosis of pathological conditions affecting this region.

These cases need to be followed to exclude associated gastric carcinoma [6] and non Hodgkin's [7] and MALT lymphoma. While endoscopy and endosonography are no doubt better [8], abdominal ultrasound using appropriate probes is also a valuable diagnostic tool.

We have become wiser after this experience and have arrived at this diagnosis in a number of patients with abdominal pain and intraluminal pyloric mass lesion. In these we observed that though the thickening was not marked, it was apparent even in the non-distended stomach and was predominantly intraluminal. In addition, the striated appearance of the gastric wall was not entirely lost and there was no perigastric extension of the disease process. The diagnosis was subsequently confirmed by endoscopy and biopsy in many patients.

 
   References Top

1.Marshall B.J. Campylobacter pyloridis and gastritis. J Infect Dis 1986; 153: 650-657.   Back to cited text no. 1    
2.Warren J.R. Unidentified curved bacilli on gastric epithelium in chronic active gastritis. Lancet 1983; 1:1273-1275.   Back to cited text no. 2    
3.John CD. Helicobacter pylori and peptic ulcer disease. AJR 1995; 164: 283-286.   Back to cited text no. 3    
4.Dooley C, Cohen H, Fitzgibbons PL, et al . Prevalance of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 1989; 321: 1562-1566.   Back to cited text no. 4    
5.Bender NG,Makuch RS. Double contrast barium examination of the upper gastrointestinal tract with non endoscopic biopsy: findings in 100 patients. Radiology 1997; 202: 355-359.   Back to cited text no. 5    
6.Forman D. An International association between Helicobacter pylori infection and gastric cancer. Lancet 1993; 341: 1351-1362.   Back to cited text no. 6    
7.Parsonnet J, Hansen S, Rodriguez L, et al . Helicobacter pylori infection and gastric lymphoma. N Engl J Med 1994; 330: 1260-1271.   Back to cited text no. 7    
8.Sackmann M, Morgner A, Rudolph B, et al . Regression of gastric MALT lymphoma after eradication of Helicobacter pylori is predicted by endosonographic staging. Gastroenterology 1997; 113: 1087-1090  Back to cited text no. 8    

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Correspondence Address:
Rajesh Gothi
South Delhi Ultrasound and X-Ray Clinic, New Delhi - 110 016
India
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Source of Support: None, Conflict of Interest: None


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