Tan CC, Shangguan XL, Lei XM, Deng FF, Wu YP, Zhang GM. Gyrus-like endoscopic changes in autoimmune gastritis with past Helicobacter pylori infection: Two case reports and review of literature. World J Gastrointest Endosc 2025; 17(9): 110850 [DOI: 10.4253/wjge.v17.i9.110850]
Corresponding Author of This Article
Guo-Min Zhang, PhD, Professor, School of Integrated Chinese and Western Medicine, Hunan University of Traditional Chinese Medicine, No. 300 Xueshi Road, Changsha 410208, Hunan Province, China. 003334@hnucm.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chuan-Chuan Tan, Xue-Li Shangguan, Fang-Fang Deng, Yang-Peng Wu, Department of Gastroenterology, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
Xiao-Ming Lei, School of Medicine, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
Guo-Min Zhang, School of Integrated Chinese and Western Medicine, Hunan University of Traditional Chinese Medicine, Changsha 410208, Hunan Province, China
Author contributions: Tan CC contributed to manuscript writing and editing, conceptualization, investigation, and methodology; Shangguan XL contributed to manuscript writing and editing, and investigation; Lei XM contributed to manuscript review and editing, methodology and conceptualization; Deng FF and Wu YP contributed to manuscript editing and data collection; Zhang GM contributed to manuscript review and editing, and supervision; all authors have read and approved the final manuscript.
Supported by the General Program of the National Natural Science Foundation of China, No. 81973920.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Min Zhang, PhD, Professor, School of Integrated Chinese and Western Medicine, Hunan University of Traditional Chinese Medicine, No. 300 Xueshi Road, Changsha 410208, Hunan Province, China. 003334@hnucm.edu.cn
Received: June 17, 2025 Revised: July 11, 2025 Accepted: August 19, 2025 Published online: September 16, 2025 Processing time: 87 Days and 15.5 Hours
Abstract
BACKGROUND
Autoimmune gastritis (AIG) is recognized endoscopically by the presence of antrum-sparing corpus-dominant atrophy, known as reverse atrophy. However, a past Helicobacter pylori (H. pylori) infection can obscure this classic pattern. We present two cases of AIG with past H. pylori infection and highlight a novel endoscopic sign that may aid AIG recognition when typical features are absent.
CASE SUMMARY
One patient reported postprandial fullness, while the other was asymptomatic. Neither had a history of H. pylori eradication therapy. Both tested negative on a urea breath test and positive for anti-parietal cell antibodies. In both patients, endoscopy revealed mucosal atrophy involving both the corpus and antrum, which was counter to the characteristic reverse atrophy pattern typically seen in AIG. Beyond the atrophic border, we observed a distinct pattern of gyrus-like changes, manifesting as elevated mucosa between deep fissures. Histologically, targeted biopsies from these gyrus-like areas revealed parietal cell degeneration, lymphocytic infiltration, and hyperplasia of enterochromaffin-like cells, consistent with early histopathologic changes seen in AIG. These results supported diagnoses of AIG with past H. pylori infection.
CONCLUSION
Gyrus-like changes may serve as a novel endoscopic clue of AIG with past H. pylori infection.
Core Tip: We present two patients diagnosed with autoimmune gastritis (AIG) after past Helicobacter pylori (H. pylori) infection. In both, the reverse atrophy characteristic of AIG was absent. We identified gyrus-like changes, characterized by mildly elevated mucosa between deep fissures, as a novel endoscopic feature. Histology confirmed the early pathology of AIG in these areas. This previously unrecognized endoscopic pattern offers a valuable clue of detecting AIG in patients with past H. pylori infection that may facilitate the early recognition and management of this condition.
