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Gastritis

Wednesday 12 November 2003

Lesional patterns

- acute gastritis
- active gastritis (active focal gastritis)
- chronic gastritis

  • lymphocytic gastritis
  • collagenous gastritis
  • granulomatous gastritis
  • eosinophilic gastritis
  • atrophic gastritis
  • hypertrophic gastritis
  • focally enhanced gastritis (#15371951#)

Etiology

- infectious gastritis

  • CMV gastritis

- dysimmunity

  • autoimmune gastritis
  • Crohn gastritis
  • gastric GVHD

- toxic gastritis
- radic gastritis
- foreign body (bezoard)
- periphery of a lesion

  • gastric ulcer
  • gastric carcinoma
  • gastrectomy remnant
  • digestive anastomosis ("stomitis")

- malnutrition
- hepatic cirrhosis
- endocrinian diseases

Reporting gastritis

A comprehensive diagnosis of gastritis should comment on the presence or absence of the graded variables and an assessment of their extent using the current guidelines.

Additionally, the presence of features such as foveolar hyperplasia, lamina propria edema, and smooth-muscle proliferation will be assessed in cases where the final diagnosis is reactive gastritis.

Likewise, the presence of erosions, eosinophils, granulomas, and infectious agents (e.g., anisakiasis, giardiasis, and Helicobacter heilmannii, formerly Gastrospirillum hominis) should be noted.

From the foregoing, it can now be appreciated that the ideal diagnostic phrase with which to conclude a report of inflammatory gastric disease is one that embraces an etiological, a topographical, and a morphological component, for example, "active, antral predominant, chronic H. pylori gastritis", or "NSAID-associated reactive gastritis".

Sometimes, although the etiology is not necessarily established, it may be inferred from the morphological findings, as in corpus restricted chronic gastritis and atrophy (autoimmune type).

In many cases, however, the cause remains unknown or is only revealed by other investigations; and to preface each diagnostic phrase with “idiopathic” would be self-defeating and misleading.

Under these circumstances, the morphological or topographical classification will suffice.

For example, the diagnosis of "chronic gastritis with multifocal atrophy" (or "multifocal atrophic gastritis"), which carries implications for the risk of progression to cancer, is not enhanced by the addition of idiopathic.

If, on the other hand, Helicobacter is identified, "chronic H. pylori gastritis with multifocal atrophy" or "Helicobacter-associated multifocal atrophic gastritis" is much more helpful.

Prognosis

The diagnosis of gastritis rests on a synthesis of the morphological and topographical findings.

These findings are interpreted in the light of possible etiological factors to generate a clinically relevant opinion providing prognostically useful information with regard to the likely disease associations and outcomes.

Pathologists should exert great caution when expressing prognostic opinions, paying particular attention to the epidemiological associations that may be peculiar to the area where they practice or the population they serve.

For example, the prognostic implications of a diagnosis of "multifocal atrophic gastritis" in areas with high gastric cancer risk (e.g., certain regions of South America or Eastern Asia) may differ substantially from those in an area where gastric cancer is uncommon (e.g., North America).

Such facts should always be kept in mind to help avoid exaggerated responses from clinicians and to minimize the possibility of inappropriate interpretations in countries where medical litigation is commonplace.

Videos

- Endoscopy of severe gastritis

References

- OLGA staging for gastritis: a tutorial. Rugge M, Correa P, Di Mario F, El-Omar E, Fiocca R, Geboes K, Genta RM, Graham DY, Hattori T, Malfertheiner P, Nakajima S, Sipponen P, Sung J, Weinstein W, Vieth M. Dig Liver Dis. 2008 Aug;40(8):650-8. PMID: #18424244#

- Staging and grading of chronic gastritis. Rugge M, Genta RM. Hum Pathol. 2005 Mar;36(3):228-33. PMID: #15791566#

- Appelman HD. Gastritis: terminology, etiology, and clinicopathological correlations: another biased view. Hum Pathol. 1994 Oct;25(10):1006-19. PMID: #7927305#

- Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Dixon MF, Genta RM, Yardley JH, Correa P. Am J Surg Pathol. 1996 Oct;20(10):1161-81. PMID: #8827022#

- Recognizing atrophy: another step toward a classification of gastritis. Genta RM. Am J Surg Pathol. 1996;20 Suppl 1:S23-30. PMID: #8694146#

- The Sydney System revisited: the Houston International Gastritis Workshop. Genta RM, Dixon MF. Am J Gastroenterol. 1995 Jul;90(7):1039-41. PMID: #7611193#