Question

The patient is a 62 year old female with nausea and abdominal pain. Routine screening endoscopy shows a diffuse gastritis and biopsy reveals small bacteria in the superficial gastric mucus.

What type of organisms do you suspect?

The biopsy also shows lymphoepithelial lesions with lymphocytes invading and destroying gastric glands. The gastric mucosa is diffusely infiltrated by small mature lymphocytes. What is your diagnosis?


How should this patient be treated?

Answer 1

The most common type of bacteria that resides in the upper GIT of humans, especially in the stomach, is Helicobacter pylori (H. pylori). It is present in almost 80% of the population and does not cause any problem in the majority of the population. This organism is one of the major factors responsible for the development of stomach ulcers or gastric ulcers. It is a gram-negative bacteria. In order to survive in the acidic environment of the stomach, it forms a coat of ammonia around it and resides below the mucosal membrane of the stomach. This case appears to be of the H. pylori infection as nausea and abdominal pain are the common symptoms associated with it. Moreover, the biopsy result confirms its presence.

Lymphoepithelial lesions and gastric glands along with the other symptoms mentioned in the question are clear cut indications of the gastric ulcers. This patient is suffering from the gastric ulcers and the prime cause of this appear to be the H. pylori infection.

For the treatment of this patient, she should be prescribed antibiotics (such as clarithromycin, amoxicillin, tetracycline, etc.) to treat H. pylori infection as it appears to be the primary cause of the ulcers. Moreover, proton pump inhibitors (such as omeprazole, etc.) should be provided to reduce the acidity of the stomach which will prevent further damage and ulcer propagation.