title: Helicobacter pylori-negative gastritis: prevalence and risk factors.
abstract: OBJECTIVE
  Recent studies using histology alone in select patients have suggested that Helicobacter pylori-negative gastritis may be common. The objective of this study was to investigate the prevalence of H. pylori among individuals with histologic gastritis.
  
  
  METHODS
  Subjects between 40 and 80 years underwent elective esophagogastroduodenoscopy at a VA Medical Center. Gastric biopsies were mapped from seven prespecified sites (two antrum, four corpus, and one cardia) and graded by two gastrointestinal pathologists, using the Updated Sydney System. H. pylori-negative required four criteria: negative triple staining at all seven gastric sites, negative H. pylori culture, negative IgG H. pylori serology, and no previous treatment for H. pylori. Data regarding tobacco smoking, alcohol drinking, nonsteroidal anti-inflammatory drug, and proton pump inhibitor (PPI) use were obtained by questionnaire.
  
  
  RESULTS
  Of the 491 individuals enrolled, 40.7% (200) had gastritis of at least grade 2 in at least one biopsy site or grade 1 in at least two sites. Forty-one (20.5%) had H. pylori-negative gastritis; most (30 or 73.2%) had chronic gastritis, five (12.2%) had active gastritis, and six (14.6%) had both. H. pylori-negative gastritis was approximately equally distributed in the antrum, corpus, and both antrum and corpus. Past and current PPI use was more frequent in H. pylori-negative vs. H. pylori-positive gastritis (68.2% and 53.8%; P=0.06).
  
  
  CONCLUSIONS
  We used multiple methods to define non-H. pylori gastritis and found it in 21% of patients with histologic gastritis. While PPI use is a potential risk factor, the cause or implications of this entity are not known.
authors.affiliation: Houston VA HSR&D Center of Excellence, Houston, TX, USA.
authors.forename: Helena
authors.initials: H
authors.lastname: Nordenstedt
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.forename: Gordana
authors.initials: G
authors.lastname: Verstovsek
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fitzgerald
authors.forename: Abeer
authors.initials: A
authors.lastname: Alsarraj
authors.forename: Yasser
authors.initials: Y
authors.lastname: Shaib
authors.forename: Maria E
authors.initials: ME
authors.lastname: Velez
authors.forename: Neena
authors.initials: N
authors.lastname: Abraham
authors.forename: Bhupinderjit
authors.initials: B
authors.lastname: Anand
authors.forename: Rhonda
authors.initials: R
authors.lastname: Cole
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003430:Cross-Sectional Studies; D016145:Endoscopy, Digestive System; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D005756:Gastritis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D006306:Health Surveys; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology