Resolution of gastrointestinal protein loss after Helicobacter pylori eradication in a patient with hypertrophic lymphocytic gastritis.
BACKGROUND
Lymphocytic gastritis is a rare condition found in approximately 1% of dyspeptic patients. An association with Helicobacter pylori infection has been described. Hypertrophic lymphocytic gastritis is a rare cause of gastrointestinal protein loss. Here, we describe a patient with hypertrophic lymphocytic gastritis, in whom gastrointestinal protein loss resolved completely following H. pylori eradication.


METHODS
A 38-year old obese man without gastrointestinal symptoms showed a markedly decreased serum protein (53 g/l, normal 66-85 g/l), a decreased serum albumin (33 g/l, normal 35-52 g/l) and decreased serum immunoglobulin G and immunoglobulin M levels. A renal cause for protein loss was excluded, liver function was normal. Endoscopy of the upper gastrointestinal tract revealed enlarged rigid gastric folds, and an H. pylori-associated lymphocytic gastritis. 99mTc-labelled albumin scintigraphy showed an increased activity in the upper left abdomen compatible with protein secretion in the stomach, and tracer pooling in the upper small bowel. Push enteroscopy with histology demonstrated a normal upper small bowel. Two months after eradication therapy, cure of H. pylori infection was documented and serum protein (71 g/l) and albumin (41 g/l) had returned to normal, while lymphocytic gastritis was still present. One year after eradication therapy endoscopy of the upper gastrointestinal tract and histology and laboratory values were normal.


CONCLUSIONS
Protein-losing gastropathy caused by H. pylori-associated hypertrophic lymphocytic gastritis can be cured solely by H. pylori eradication therapy.
Madisch
Ahmed
A
Medical Department I, Technical University Hospital, Dresden, Germany. madisch@mk1.med.tu-dresden.de
Aust
Daniela
D
Morgner
Andrea
A
Grossmann
Dana
D
Schmelz
Renate
R
Kropp
Joachim
J
Ehninger
Gerhard
G
Baretton
Gustavo
G
Miehlke
Stephan
S
D000328:Adult; D001798:Blood Proteins / Q000378:metabolism; D016099:Endoscopy, Gastrointestinal; D005753:Gastric Mucosa / Q000378:metabolism*; D005758:Gastritis, Hypertrophic / Q000188:drug therapy / Q000378:metabolism* / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D016480:Helicobacter pylori; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D011506:Proteins / Q000378:metabolism*; D011860:Radiography, Abdominal
D001798:Blood Proteins; D011506:Proteins