E0231 - The Odd Couple: Active H. pylori Infection Within Long Segment Barrett’s Esophagus

Rei Mitsuyama, MD¹, Weibiao Cao, MD¹, Sarah M. Hyder, MD, MBA^2
1Brown University, Providence, RI; ²Lifespan Physician Group - Brown University, East Providence, RI

Introduction: Barrett’s esophagus (BE) is a consequence of poorly-controlled GERD leading to intestinal metaplasia, which predisposes to esophageal cancer. Similarly, there is a well-established link between Helicobacter pylori and development of gastric cancer. However, there is a negative association between H pylori and risk of BE. Here, we present a rare case of H Pylori infection within Barrett's mucosa.

Case Description/Methods: A 54-year-old woman was referred for one month of dysphagia to solids. She described food sticking in her mid-esophagus without difficulty swallowing pills or liquids. She also endorsed significant heartburn and belching but denied systemic symptoms, regurgitation, abdominal pain, or weight loss. EGD demonstrated a 5 cm segment of circumferential salmon-colored mucosa suspicious for Barrett’s esophagus, a small esophageal ulcer, and a normal stomach and duodenum. Gastric biopsies revealed mild gastritis with H pylori organisms. Esophageal biopsies showed intestinal metaplasia consistent with Barrett’s esophagus as well as H pylori organisms. Quadruple therapy was initiated with metronidazole, tetracycline, omeprazole, and bismuth.

Discussion: We describe a rare case of H pylori discovered within long-segment Barrett’s esophagus. Evidence suggests an inverse association between H pylori and BE. However, a recent meta-analysis demonstrated that this association disappeared in patients with GERD. One proposed mechanism for H pylori’s protectiveness against BE is decreased gastric acid production. Together, this suggests H pylori protects against BE by preventing development of GERD but once GERD is present, H pylori is no longer protective. Thus, our simultaneous diagnosis of BE and H pylori could be explained by long-standing GERD and BE prior to H pylori infection.

While it is uncommon to diagnose H pylori and BE together, it is even rarer to see H pylori within Barrett’s mucosa, given the organism’s proclivity for gastric epithelium. One potential explanation is that this patient’s significant GERD allowed reflux of H pylori organisms into the esophagus, leading to colonization of the metaplastic epithelium. Furthermore, there may be microscopic satellites of gastric mucosa within the segment of BE, providing a friendlier environment in which the organisms could grow.

More observation is needed to determine the significance and long term effects of active H pylori infection in Barrett's mucosa and if this facilitates progression to dysplasia or carcinoma.



Disclosures:


Rei Mitsuyama, MD¹, Weibiao Cao, MD¹, Sarah M. Hyder, MD, MBA². E0231 - The Odd Couple: Active H. pylori Infection Within Long Segment Barrett’s Esophagus, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.