Is Helicobacter pylori (H. pylori) a known cause of gastritis?

H. pylori is the Primary Cause of Gastritis

Helicobacter pylori infection is the most common cause of gastritis worldwide and plays a causal role in its pathogenesis. 1, 2

Relationship Between H. pylori and Gastritis

• H. pylori is strongly associated with chronic gastritis and is considered the principal etiologic agent 1, 3
• The infection causes both acute granulocytic and chronic mononuclear inflammation of the gastric mucosa 2
• H. pylori has unique properties that allow it to colonize gastric epithelium in an acidic environment, leading to inflammatory changes 3
• The bacterium is recognized as the most common chronic human bacterial infection and the most common cause of gastritis 1

Evidence Supporting Causal Relationship

• Eradication of H. pylori results in the disappearance of both acute and chronic gastritis, supporting its causal role 2
• After successful H. pylori eradication:
  • Acute inflammation disappears within 6 weeks
  • Chronic inflammation gradually decreases over time
  • Corpus mucosa returns to normal in all successfully treated patients within 12 months
  • Antral mucosa returns to normal in the majority of patients 2
• No significant reduction in gastritis intensity occurs in patients with unsuccessful eradication or in untreated controls 2

Progression and Clinical Significance

• H. pylori gastritis can progress to severe gastroduodenal pathologies, including:
  • Peptic ulcer disease
  • Gastric cancer
  • Gastric mucosa-associated lymphoid tissue (MALT) lymphoma 3, 4
• The pathophysiology involves complex bacterial virulence mechanisms interacting with host immune responses and environmental factors 3
• Different gastritis phenotypes determine the potential progression to various gastroduodenal pathologies 3

Management Implications

• H. pylori gastritis is defined as an infectious disease that requires therapy in all infected individuals 4
• Eradication of H. pylori:
  • Heals gastritis 5
  • Prevents progression to atrophic gastritis in patients receiving long-term PPI therapy 5
  • Is recommended for prevention of gastric cancer, especially before the development of preneoplastic conditions 5
• Treatment consists of acid suppressants combined with antibiotics and/or bismuth 3

Pitfalls and Caveats

• H. pylori prevalence varies globally according to location and sanitation standards 3
• Increasing antibiotic resistance demands susceptibility testing, resistance surveillance, and antibiotic stewardship 3
• Only a fraction of infected persons develop peptic ulcer disease or gastric cancer 6
• Outcome variation depends on microbial strain heterogeneity, host factors, and environmental influences 6
• Long-term PPI treatment in H. pylori-positive patients can accelerate progression to atrophic gastritis 5

H. pylori infection is now recognized as the primary cause of chronic gastritis, with eradication of the bacterium resulting in resolution of the inflammatory process, confirming the causal relationship between this pathogen and gastritis.