Clin Endosc.  2021 Jan;54(1):1-3. 10.5946/ce.2021.007.

Giant Rugae in Helicobacter pylori-Infected Stomachs

• Lee SY

• KMID: 2512301
• DOI: http://doi.org/10.5946/ce.2021.007

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  Fig. 1. Endoscopy and serum assay findings of the giant rugae in a 62-year-old man with an Helicobacter pylori infection. (A) Initial endoscopy of the gastric body: the mucosal surfaces of the gastric rugae showed diffuse redness and poor distention upon air inflation. Biopsies of the gastric rugae revealed an active H. pylori infection without malignant cells. The serum pepsinogen (PG) I (91.6 ng/mL) and PG II (15.5 ng/mL) levels were elevated, and the PG Ⅰ/Ⅱ ratio was 5.9 on the day of endoscopy. The serum anti-H. pylori IgG assay revealed seropositivity (61.4 AU/mL) using the Chorus H. pylori IgG assay (DIESSE, Siena, Italy), which has a sensitivity of 100% and a specificity of 75.4% in Korean [10]. (B) Follow-up endoscopy after successful H. pylori eradication was confirmed by the negative urea breath test: poor distention was still noticed owing to the hard and thick rugae. Compared with the findings before the eradication, a progression to tortuosity was found in the giant rugae with the regression of diffuse redness. There were no malignant cells or H. pylori in the biopsied specimens. Nevertheless, the serum PG I (100.2 ng/mL) and PG II (16.8 ng/mL) levels were higher than those before the eradication. The PG Ⅰ/Ⅱ ratio was 6.0, and the serum anti-H. pylori IgG titer was 46.0 AU/mL. (C) Computed tomography of the abdomen: imaging was performed because of the persistent giant rugae and increased serum PG II levels after H. pylori eradication. A diffusely enhanced wall thickening of the entire stomach, suggesting Borrmann type IV gastric cancer, was found on a coronal section. (D) Gross image of the resected stomach: after total gastrectomy, a 19.0×18.0×1.0 cm, diffuse-type, poorly cohesive carcinoma was diagnosed. Cancer cells were invading the visceral peritoneum (pT4a). Metastases were found in 17 of the 30 regional lymph nodes (pN3b). Resection margins were free of carcinoma.

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