Korean J Gastroenterol.  2023 Dec;82(6):269-281. 10.4166/kjg.2023.139.

Infectious Gastric Diseases Other than Helicobacter

• Jo H
• Shin CM

• KMID: 2549794
• DOI: http://doi.org/10.4166/kjg.2023.139

Abstract

In addition to Helicobacter pylori, the acute bacterial causes of infectious gastritis, include phlegmonous gastritis, gastric tuberculosis, and gastric syphilis. Bacterial gastritis often improves with appropriate broad-spectrum antibiotics, emphasizing the need for prompt diagnosis and treatment based on the clinical and endoscopic findings. Among viral gastritis, cytomegalovirus gastritis, primarily occurring in immunocompromised patients, necessitates antiviral intervention, while immunocompetent individuals typically achieve amelioration by administering proton pump inhibitors. In contrast, most gastric infections caused by the Epstein-Barr virus (EBV) are asymptomatic, but an EBV infection is a cause of stomach cancer. EBV-associated gastric cancer exhibits distinct clinical, pathological, genetic, and post-genetic mutation features, making it clinically significant. The colonization of Candida albicans in the stomach is uncommon, and typical antifungal treatment is unnecessary. Candida infections in gastric ulcers can be treated with anti-ulcer treatment alone. Lastly, anisakidosis in the stomach, which occurs when consuming raw seafood, can manifest in various clinical presentations and is typically treated through endoscopic removal of the nematode. This article aims to contribute to the rapid diagnosis and treatment of rare stomach infections beyond Helicobacter pylori in real clinical situations.

Keyword

Phlegmonous gastritis; Gastric syphilis; Cytomegalovirus gastritis; Ebstein-Barr virus gastritis; Gastric candidiasis

Figure

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  Fig. 1 Endoscopic and computed tomography findings of phlegmonous gastritis. An 84-year-old female with diabetes visited the emergency department due to acute abdominal pain and vomiting. She had fever and severe abdominal tenderness. Esophagogastroduodenoscopy (A–D) revealed necrotic-appearing mucosal fold thickening covered with purulent exudate, yellowish pus overlying mucosa, and a pocket exposed to the lumen (C, D). Computed tomography (E, F) shows diffuse edematous layered wall thickening of the stomach (Courtesy by prof. Jun Haeng Lee, Department of Internal Medicine, College of Medicine, Sungkyunkwan University).

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  Fig. 2 Endoscopic findings of gastric syphilis. Infiltrative lesion with pyloric stenosis (A). Multiple gastric ulcers with heaped nodular edges (B). Diffuse superficial ulcers with mucosal friability and bleeding (C). Thickened folds (D).42

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  Fig. 3 Initial and follow-up endoscopic findings of gastric cytomegalovirus (CMV) infection in an immunocompetent patient. A 79-year-old male visited the gastroenterology clinic due to melena. The initial endoscopy (A, B) showed multiple discrete ulcers at the angle and less curvature of the lower body. The pathologic diagnosis of the initial biopsy was a few atypical glands in the background of chronic active gastritis. The patient was treated using a proton pump inhibitor (PPI) for two months. The first follow-up endoscopy (C) showed improved and healing state ulcers, but the biopsy results revealed a few atypical cells with nuclear inclusion, and CMV immunohistochemical (IHC) staining was positive. The patient received additional PPI treatment for two months. The second follow-up endoscopy (D) showed an ulcer scar, and the biopsy showed chronic gastritis and a negative CMV IHC.

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  Fig. 4 Endoscopic findings of gastric candidiasis. Multiple active ulcers (A, B) with fold convergence at great curvature and posterior wall of proximal antrum and body. A biopsy was performed, and the pathology was chronic active gastritis with ulcer detritus and many fungal hyphae, consistent with candidiasis. After proton pump inhibitor treatment for two months, the follow-up endoscopy (C, D) showed healed whitish ulcer scars.

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  Fig. 5 Endoscopic findings of gastric anisakidosis. A 57-year-old male visited the gastroenterology clinic due to epigastric pain. He had a history of eating raw fish one day earlier. Endoscopy revealed a visible worm with partial invasion (A), which was removed by forceps (B).

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