Incidentally Detected Persistent Helicobacter heilmannii Gastritis in a Korean Woman With a Normal Endoscopic Examination: Successful Eradication After Salvage Therapy

Helicobacter heilmannii is an uncommon, non-Helicobacter pylori gastric organism associated with chronic gastritis, peptic ulcer disease, gastric mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma.Because the stomach may appear normal endoscopically, diagnosis often depends on histologic examination.Presented is a 59-year-old Korean woman with intermittent epigastric pain and heartburn, as well as a maternal family history of gastric cancer.Upper endoscopy demonstrated a small hiatal hernia with an otherwise normal-appearing stomach.Antral biopsies showed moderate chronic active gastritis with H. heilmannii colonization without metaplasia, dysplasia, or malignancy.The patient was treated with clarithromycin-based triple therapy, with symptomatic improvement.Repeat upper endoscopy with gastric mapping four months later demonstrated persistent H. heilmannii infection.She then completed 14 days of optimized bismuth quadruple therapy.An additional follow-up upper endoscopy with gastric mapping four months later showed normal gastric histology without residual Helicobacter.This highlights the potential for H. heilmannii infection despite a normal endoscopic appearance, the limitations of symptomatic response as evidence of eradication, and the importance of repeat gastric biopsies after treatment failure.