H. pylori bacteria inflames stomach

Dear Dr. Roach: My 77-year-old aunt, who is in good health, had an endoscopy and was told that her stomach biopsy was positive for H. pylori. She was treated for 14 days. After a month, a breathing test showed no signs of H. pylori. However, I read her biopsy report, and it showed “secondary interstitial chronic gastritis with plasmacytosis.” The nurse said it is due to the H. pylori but also asked if my aunt had ever had radiation. Should we be concerned?

A.M.F.

Answer: Helicobacter pylori is the major source of stomach ulcers. It can cause stomach symptoms without causing ulcers.

Chronic gastritis is one of those typical changes with an H. pylori infection. “Gastritis” means “inflammation of the stomach.” The inflammatory cells usually include plasma cells, which are the cells that make antibodies. “Plasmacytosis” means “lots of plasma cells,” which is compatible with her diagnosis. However, H. pylori is not the only cause. Radiation can cause inflammation of the stomach as well — hence the question by the nurse — but pathologists can normally tell the difference.

A breath test looks for the urea made by the bacterial enzyme urease. It’s an excellent way to confirm eradication of the organism.

Dear Dr. Roach: Iaman 86-year-old male who has been suffering from low iron and hemoglobin for approximately 13 months. I have had six iron infusions. After the infusions, the iron level is good. However, after three months, the iron drops and another infusion is necessary. Why does the iron continue to drop?

W.P.

Answer: The time course suggests that you have an ongoing loss of iron. Iron is found in blood, so it’s almost always blood loss that leads to iron deficiency when diet and absorption are normal. Hidden blood loss is most common in the GI tract. Iron loss can occasionally occur from the small bowel, the liver and bile system, or even from nosebleeds. Very occasionally, no cause is found, and people are just left on iron replacement treatment.

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