Varioliform-type lymphocytic gastritis: Treating H. pylori or (rather) something else?

A 71-year-old patient presented with dyspeptic complaints. Upper endoscopy indicated multiple small nodules with central depression in the gastric body and, to a much lesser extent, antrum (Fig. 1 A and B). Albeit the proximal stomach remained unremarkable without enlarged rugal folds, these findings were highly suggestive of varioliform gastritis (or octopus-sucker gastritis) reflective of lymphocytic gastritis (LG). Indeed, histopathology of targeted and systematic biopsies indicated prominent lymphoplasmacytic infiltration within the surface epithelium and gastric pits with intraepithelial lymphocytosis well >25/100 epithelial cells (Fig. 1 C, H&E, x10; inset CD8, x10). Overall, both endoscopy and histopathology indicated gastric body-predominant LP. Of note, histopathology including Giemsa staining and biochemical testing (urease, stool antigen) proved negative for Helicobacter pylori. Likewise, ancillary H pylori and celiac disease serology yielded unremarkable results. Nevertheless, the patient underwent “eradication” treatment using a conventional French triple treatment for 7 days. Albeit more effective eradication regimen and treatment durations have been established for H pylori eradication, we chose this regimen analogous to the only randomised trial for lymphocytic gastritis with high remission rates irrespective of H pylori status. Following this, symptomatic, endoscopic and histopathological remission was documented (Fig. 1 D, H&E, x10).