H. pylori-associated chronic gastritis: status update on the problem

Abstract

Chronic gastritis is a group of chronic diseases that are morphologically characterized by persistent inflammatory infiltrate and impaired cellular turnover with the development of intestinal metaplasia, atrophy, and epithelial dysplasia in the gastric mucosa. Numerous studies have shown that Helicobacter pylori (H. pylori) infection is the absolutely dominant etiological factor of CG worldwide. Given this fact, the Expert Council of the latest Maastricht VI 2022 consensus recommended that H. pylori is to be treated as a pathogen, which always results in the development of CG. The prevalence of H. pylori-associated CG is about 44.3–48.5%, however 80–90% of cases are asymptomatic. In H. pylori­infected patients with dyspepsia and no other pathology of the gastroduodenal region, which has been confirmed endoscopically, clinical manifestations can be interpreted as part of H. pylori­associated CG if a long-lasting remission of symptoms has been achieved after successful eradication therapy. While patients with persistent dyspeptic symptoms can be considered as patients with functional dyspepsia, despite successful eradication therapy. Advanced endoscopic techniques (narrow band imaging (NBI) endoscopy, high resolution endoscopy, chromoendoscopy, laser confocal endomicroscopy) are precise and reproducible methods for diagnosing precancerous changes in the mucous membrane. However, the diagnosis of CG requires that inflammatory cells have been histologically detected in the lamina propria. The CG therapy aims to reach a persistent relief of dyspeptic symptoms of the disease (if any), as well as resolution of inflammatory processes and prevention of the progression of precancerous changes in the gastric mucosa. The achievement of these goals is primarily determined by the timely diagnosis of H. pylori infection and successful eradication therapy.