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422.e2 Helicobacter Gastritis

Helicobacter Gastritis Client Education
Sheet
VetBooks.ir Etiology and Pathophysiology

BASIC INFORMATION
normal in infected animals, are important
• Multiple species of Helicobacter have been • Abdominal radiographs, while frequently
Definition isolated from dogs and cats: to rule out other causes of vomiting; gastric
Inflammation of the stomach as a result of ○ Dog: H. felis, H. bizzozeronii, H. salomonis, distension from dysmotility may be seen in
infection with any one of several pathogenic H. bilis, H. heilmannii, and Flexispira some infected dogs and cats.
Helicobacter spp bacteria rappini
○ Cat: H. felis, H. pametensis, H. pylori, H. Advanced or Confirmatory Testing
Epidemiology heilmannii. Approximately 41%-100% of • Noninvasive studies
SPECIES, AGE, SEX healthy cats and 57%-100% of vomiting ○ Serologic titers: not commercially available;
Dogs and cats can be infected. There is no cats have Helicobacter-like organisms. specificity of 95% and sensitivity of 79%
breed, age, or sex predisposition. • Pathogenicity varies. when ELISA and immunoblotting are
• Gastritis varies in severity and is frequently used in combination
RISK FACTORS lymphoplasmacytic. Gastric erosion and ○ Urea breath or blood test: requires a
Environmental conditions may play a role ulceration have not been reliably documented radiolabeled-urea test meal; may be useful
because higher infection rates are found in in dogs or cats as a consequence of infection. for monitoring successful therapy; limited
shelter and colony dogs and cats compared It is unknown if the pathophysiologic mecha- to specialty facilities
with pets. nisms in humans (ammonia production by ○ Polymerase chain reaction (PCR) testing
bacterial urease and other secretory products of saliva or fecal samples: high sensitivity,
CONTAGION AND ZOONOSIS that damage epithelial cells and induce gastric but specificity is low; not widely available
• The mode of transmission is unknown, acid secretion) occur in dogs and cats. • Invasive studies
although oral-oral and fecal-oral routes are ○ Biopsy (endoscopic or surgical) and
speculated. DIAGNOSIS histologic evaluation: Warthin-Starry silver
○ Vector transmission (flies) may occur. stains, Giemsa, or toluidine blue improve
○ Water-borne infections may be important Diagnostic Overview identification over routine hematoxylin
in certain areas. Helicobacter spp are not conclusively pathogenic and eosin (H&E) staining. Squash preps
○ Helicobacter has zoonotic potential. in all dogs and cats, and their presence is stained with Diff-Quik are useful for rapid
• Helicobacter spp have been identified in the often noted incidentally on histologic exam identification.
saliva and dental plaque of dogs, supporting of gastric biopsies. The diagnosis of Helicobacter ○ Rapid urease testing: performed on
the concern about oral-oral transmission infection is confirmed by gastric biopsy, but endoscopic biopsies in a urea broth with
(dog-to-dog or dog-to-human). the pathogenic significance in dogs and cats is phenol red as a pH indicator. Results in
• H. pylori is rarely isolated from cats and controversial; other concurrent or underlying 1-3 hours (up to 24 hours)
never from dogs; however, the potential for diagnoses should be pursued when possible ○ Culture: least sensitive method because
zoonotic transmission is a reasonable concern. in pets with gastrointestinal signs or ulcers organisms are difficult to culture; can
In humans, H. pylori infection is associated (p. 1225). identify antimicrobial susceptibility
with peptic ulcer disease and an increased ○ Polymerase chain reaction (PCR) on
risk of gastric cancer. Differential Diagnosis gastric biopsies: high sensitivity and
• There are reports of H. canis, H. felis, and • Primary gastric diseases causing chronic specificity; not widely available
H. heilmannii infections in people that were vomiting (pp. 1293 and 1294)
presumably acquired from dogs and cats, ○ Food hypersensitivity/allergy or intolerance TREATMENT
with associated bacteremia, peptic ulcer ○ Gastric parasites
disease, and gastritis. ○ Chronic idiopathic gastritis (lympho- Treatment Overview
• Anthropozoonosis (human-to-animal trans- plasmacytic or eosinophilic, atrophic, Identification of Helicobacter organisms or
mission) is likely in cats. hypertrophic) other evidence of helicobacteriosis in dogs and
○ Foreign body cats warrants treatment if signs of gastritis are
Clinical Presentation ○ Gastric neoplasia present and there is concurrent evidence of
HISTORY, CHIEF COMPLAINT • Nongastric diseases causing vomiting chronic gastritis. Eradication of the organism
• Helicobacter organisms can be identified in ○ Systemic diseases (hypoadrenocorticism, should be the goal for long-term resolution
healthy animals. hyperthyroidism, heartworm disease, renal of clinical signs. The author has identified
• Chronic vomiting, intermittent inappetence, disease, liver disease, neoplasia) helicobacteriosis as a cause of acute gastritis
and pica may be seen. ○ Inflammatory bowel disease or primary in dogs. Treatment is identical, although the
• Acute gastritis with marked vomiting and intestinal neoplasia addition of metoclopramide (IV constant-
anorexia (with gastroparesis) may be seen. In ○ Other causes of partial intestinal obstruc- rate infusion, SQ, or orally) is sometimes
the author’s experience, these cases are more tion (e.g., foreign body) or dysmotility required.
common in hospitalized dogs and dogs with (e.g., dysautonomia).
recent exposure to feces from other dogs ○ Drug therapy Acute General Treatment
in kennels, grooming parlors, or veterinary • Triple therapy: amoxicillin 20-25 mg/kg PO
hospitals. Initial Database q 12h; metronidazole 20-30 mg/kg PO q
• CBC, serum biochemistry profile, urinalysis, 24h; and clarithromycin 7.5-12.5 mg/kg PO
PHYSICAL EXAM FINDINGS and fecal flotation are normal in Helicobacter q 12h for 14 days (first choice)
There are no specific physical exam findings gastritis but are indicated to identify other • Various combinations of antibiotics
that suggest Helicobacter gastritis. (systemic) causes of vomiting. (amoxicillin, metronidazole, doxycycline,

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