Helicobacter‐negative gastritis: a distinct entity unrelated to Helicobacter pylori infection

Summary Background Helicobacter ‐negative gastritis is diagnosed when no organisms are detected in a gastric mucosa with typical features of Helicobacter gastritis ( Hp ‐gastritis). If Helicobacter ‐negative gastritis consisted mostly of ‘missed’ Helicobacter infections, its prevalence should represent a constant percentage of these infections in a population, and their clinico‐epidemiological features would overlap. Aim To compare the epidemiologic patterns of Hp ‐positive and Hp ‐negative gastritis. Methods From a pathology database, we extracted demographic, clinical and histopathological data from patients with gastric biopsies (1.2008–12.2013). We allocated patients to high (≥12%) and low (≤6%) H. pylori prevalence regions defined by ZIP code‐based data. The prevalence of H. pylori ‐positive and ‐negative gastritis by sex, age and state were expressed as a per cent of the total study population stratified accordingly. Results Of 895 323 patients, 10.6% had Hp ‐gastritis and 1.5% Helicobacter ‐negative gastritis. Hp ‐gastritis, but not Helicobacter ‐negative gastritis, was more common in males than females ( OR 1.17, 95% CI : 1.16–1.19). While Hp ‐gastritis was more prevalent in high than in low‐prevalence areas ( OR 3.65, 95% CI : 3.57–3.74), Helicobacter ‐negative gastritis was only minimally affected by the underlying H. pylori prevalence (1.7% vs. 1.5%). The age‐specific prevalence of Hp ‐gastritis peaked in the 4th to 5th decades; Helicobacter ‐negative gastritis exhibited a low and relatively flat pattern. The geographic distribution of H. pylori ‐positive and ‐negative gastritis showed no significant correlation. Intestinal metaplasia was found in 13.0% of patients with Hp ‐gastritis and in 6.1% of those with Helicobacter ‐negative gastritis ( OR 0.43, 95% CI : 0.40–0.47). Conclusion These data suggest that Helicobacter ‐negative gastritis is, in the vast majority of cases, a nosologically and epidemiologically distinct entity that deserves further investigation.