Nodular gastritis in adults: clinical features, endoscopic appearance, histopathological features, and response to therapy.
OBJECTIVE
The present study aims to determine the prevalence of nodular gastritis (NG) and ascertain its clinical presentation and histopathological features in adults. It also assesses its association with Helicobacter pylori and the normalization of endoscopic features, symptoms, and histology after anti H. pylori therapy.


METHODS
A total of 7140 patients undergoing upper gastrointestinal endoscopy were studied. Patients showing nodularity of the gastric mucosa at endoscopy and an age- and sex-matched control group with normal gastric mucosa underwent biopsies from the gastric antrum and fundus. The biopsies were assessed for the presence of mucosal inflammation, activity, eosinophils, atrophy, lymphoid follicles, H. pylori, and the presence of intestinal metaplasia. Patients with NG were given triple therapy. Endoscopy and biopsy was repeated after 4 weeks of stopping therapy. The symptoms of the patients and histology were assessed pre- and post-therapy.


RESULTS
Thirty-two patients with an age range of 20-65 years presenting with NG and 40 age- and sex-matched controls were included in the study. Presenting symptoms were epigastric pain (56%), nausea (75%), vomiting (50%) and abdominal bloating (62.5%). All these symptoms regressed significantly after 2 week of triple therapy against H. pylori. A marked improvement in histopathological features was seen post-therapy where the presence of lymphoid aggregates, eosinophils in the mucosa, atrophy, and intestinal metaplasia improved significantly (P < 0.05) after therapy, as compared to the control group of patients.


CONCLUSIONS
The symptoms of NG and endoscopic features regress significantly after H. pylori therapy with a proton pump inhibitor and two antibiotics and should routinely be given to treat this form of gastritis. This may prevent progression to further complications.
Dwivedi
Manisha
M
Departments of Gastroenterology and Pathology, Moti Lal Nehru Medical College, University of Allahabad, Allahabad, India. manisha_dwivedi@hotmail.com
Misra
Sri Prakash
SP
Misra
Vatsala
V
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology; D005756:Gastritis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors