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Helicobacter pylori-Negative Gastritis: Prevalence and Risk Factors

The American Journal of Gastroenterology volume 108, pages 6571 (2013) | Download Citation



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.


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.


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).


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.

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The views expressed reflect those of the authors and not necessarily those of the National Cancer Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Department of Veterans Affairs and/or Baylor College of Medicine. The NIDDK had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.

Author information


  1. Houston VA HSR&D Center of Excellence, Houston, Texas, USA

    • Helena Nordenstedt
    • , Jennifer R Kramer
    • , Stephanie Fitzgerald
    • , Abeer Alsarraj
    • , Neena Abraham
    •  & Hashem B El-Serag
  2. Sections of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

    • Helena Nordenstedt
    • , David Y Graham
    • , Massimo Rugge
    • , Yasser Shaib
    • , Maria E Velez
    • , Neena Abraham
    • , Bhupinderjit Anand
    • , Rhonda Cole
    •  & Hashem B El-Serag
  3. Department of Medicine, Houston, Texas, USA

    • David Y Graham
    • , Yasser Shaib
    • , Maria E Velez
    • , Neena Abraham
    • , Bhupinderjit Anand
    • , Rhonda Cole
    •  & Hashem B El-Serag
  4. Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

    • Jennifer R Kramer
  5. Surgical Pathology and Cytopathology Unit, Department of Diagnostic Medical Sciences and Special Therapies, University of Padova, Padova, Italy

    • Massimo Rugge
  6. Department of Pathology at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA

    • Gordana Verstovsek


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Competing interests

Guarantor of the article: Hashem B. El-Serag, MD, MPH.

Specific author contributions: Funding, conception, design, analysis, interpretation of the results, manuscript writing, editing, and decision to publish: Hashem B. El-Serag; conception, data collection, editing manuscript, and decision to publish: Helena Nordensted; analysis, editing manuscript, and decision to publish: David Y. Graham, Massimo Rugge, Yasser Shaib, Maria E. Velez, Neena Abraham, and Bhupinderjit Anand; data collection, editing manuscript, and decision to publish: Jennifer R. Kramer, Stephanie Fitzgerald, and Abeer Alsarraj; analysis, editing manuscript, and decision to publish: Gordana Verstovsek; analysis, data collection, editing manuscript, and decision to publish: Rhonda Cole.

Financial support: This work was partly supported by the VA HSR&D Houston Center of Excellence (HFP90-020), Grant support: NCI R01 116845 and NIDDK K24-04-107.

Potential competing interests: None.

Corresponding author

Correspondence to Hashem B El-Serag.

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