Kitadai Yuki, Takigawa Hidehiko, Shimizu Daisuke, Ariyoshi Misa, Tsuboi Akiyoshi, Tanaka Hidenori, Yamashita Ken, Hiyama Yuichi, Kishida Yoshihiro, Urabe Yuji, Ishikawa Akira, Kuwai Toshio, Oka Shiro
Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Dig Endosc. 2025 Sep;37(9):998-1009. doi: 10.1111/den.15042. Epub 2025 May 9.
Conventional nodular gastritis has been known to be caused by Helicobacter pylori infection. Several cases of gastric mucosa-associated lymphoid tissue (MALT) lymphoma with non-H. pylori Helicobacters (NHPH) exhibit endoscopic findings resembling nodular gastritis. Considering the differences in malignancy, distinguishing between these two conditions is crucial. This study aimed to identify the distinguishing endoscopic features of NHPH-induced gastric MALT lymphoma with nodular gastritis-like appearance (NHPHi-MNG) and H.-induced conventional nodular gastritis (HPi-NG).
Between 2011 and 2022, we analyzed 17 patients with NHPHi-MNG and 50 patients with HPi-NG at Hiroshima University Hospital and evaluated nodule morphology and distribution patterns.
Compared with the HPi-NG group, the NHPHi-MNG group exhibited significantly larger nodules (2.5 vs. 2.0 mm, P < 0.05) with protruded morphology (protruded/superficial, elevated: 14/3 vs. 8/42, P < 0.05), most prominently in the gastric angulus. The variability in nodule size was significantly higher in the NHPHi-MNG group than in the HPi-NG group (0.85 vs. 0.37 mm, P < 0.05), reflecting nodule heterogeneity. The distance from the gastric angulus to the proximal end of the nodular lesions was significantly greater in the NHPHi-MNG group than in the HPi-NG group (4.4 vs. 1.7 cm, P < 0.05). The nodules in the HPi-NG group were smaller, superficial, elevated, and most prominent in the gastric antrum compared with those in the NHPHi-MNG group. They were predominantly distributed in the gastric antrum with a homogeneous morphology.
NHPHi-MNG and HPi-NG can be endoscopically differentiated according to nodule morphology and distribution. Recognizing these distinguishing features is essential for an accurate diagnosis.
传统结节性胃炎已知由幽门螺杆菌感染引起。几例伴有非幽门螺杆菌（NHPH）的胃黏膜相关淋巴组织（MALT）淋巴瘤表现出类似结节性胃炎的内镜检查结果。考虑到恶性程度的差异，区分这两种情况至关重要。本研究旨在确定具有结节性胃炎样外观的NHPH诱导的胃MALT淋巴瘤（NHPHi-MNG）和幽门螺杆菌诱导的传统结节性胃炎（HPi-NG）的鉴别内镜特征。
2011年至2022年期间，我们分析了广岛大学医院的17例NHPHi-MNG患者和50例HPi-NG患者，并评估了结节形态和分布模式。
与HPi-NG组相比，NHPHi-MNG组的结节明显更大（2.5对2.0毫米，P<0.05），形态突出（突出/浅表、隆起：14/3对8/42，P<0.05），最明显的是胃角部。NHPHi-MNG组结节大小的变异性明显高于HPi-NG组（0.85对0.37毫米，P<0.05），反映了结节的异质性。NHPHi-MNG组从胃角到结节性病变近端的距离明显大于HPi-NG组（4.4对1.7厘米，P<0.05）。与NHPHi-MNG组相比，HPi-NG组的结节更小、浅表、隆起，在胃窦部最明显。它们主要分布在胃窦部，形态均匀。
NHPHi-MNG和HPi-NG可以根据结节形态和分布进行内镜鉴别。认识到这些鉴别特征对于准确诊断至关重要。
