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chronic gastritis

Wednesday 21 January 2004

Digital case

- HPC:311 : Follicular gastritis and active chronic gastritis, non-atrophical, Helicobacter pylori-associated

Definition: Chronic gastritis is an inflammatory condition of the gastric mucosa that may include structural alterations of the glandular compartment.

Sydney system of grading

Feature Definition Grading Guidelines
Chronic inflammation Increased lymphocytes and plasma cells in the lamina propria Mild, moderate, or severe increase in density
Activity Neutrophilic infiltrates of the lamina propria, pits, or surface epithelium Less than one third of pits and surface infiltrated = mild; one third to two thirds = moderate; more than two thirds = severe
Atrophy Loss of specialized glands from either antrum or corpus Mild, moderate, or severe loss
Intestinal metaplasia Intestinal metaplasia of the epithelium Less than one third of mucosa involved = mild; one third to two thirds = moderate; more than two thirds = severe
Helicobacter pylori H. pylori density Scattered organisms covering less than one third of the surface = mild colonization; large clusters or a continuous layer over two thirds of surface = severe; intermediate numbers = moderate colonization

Non-specific chronic gastritis has many etiologies that produce similar or overlapping histologic features. For this reason, the correlation between clinical symptoms, endoscopic features, and histologic evidence ofchronic gastritis is poor.

However, three distinct forms of chronic gastritis can be delineated:
- diffuse antral chronic gastritis
- fundic chronic gastritis
- multifocal chronic gastritis

Diffuse antral and multifocal gastritis are sometimes referred to as type B gastritis, and both share HP as an etiologic factor.

The major difference between the two is that diffuse antral gastritis is non atrophic, whereas multifocal gastritis progresses to atrophic gastritis.

These forms of gastritis show specific histologic, clinical, epidemiologic, and etiologic parameters.

Chronic gastritis can be further classified as active or quiescent depending on its histologic features.

The different forms of chronic gastritis show different gastric localizations:
- autoimmune gastritis predominantly affects the fundus and body and spares the antrum.
- hypersecretory gastritis predominantly affects the antrum and is associated with duodenal ulcers.
- multifocal atrophic gastritis starts at the corpus–antral junction spreading proximally and distally. This form associates with gastric ulcers along the lesser curvature.

Multifocal atrophic gastritis usually complicates longstanding
HP infections, it although rarely complicates other conditions.

Types

- non-atrophic gastritis

  • antral-predominant non-atrophic gastritis
  • non-atrophic pangastritis

- chronic atrophic gastritis (CAG)

  • antrum-restricted atrophic gastritis
  • corpus-restricted atrophic gastritis
  • multifocal atrophic gastritis
  • atrophic pangastritis

- chronic active gastritis

  • focal active gastritis
  • focally enhanced gastritis

- granulomatous gastritis
- collagenous gastritis
- lymphocytic gastritis
- gastric graft-versus-host disease

Etiology

- infection-associated gastritis

  • Helicobacter-associated gastritis

- dysimmune gastritis

  • IBDs-associated gastritis
    • Crohn gastritis
  • immune deficiency-associated gastritis
    • CVID-associated gastritis (common variable immune deficiency)
    • XLA-associated gastritis (X-linked agammaglobulinemia)
    • XLP-associated gastritis (X-linked lymphoproliferative syndrome)

- drug-induced gastritis

  • NSAID-induced gastritis

- toxic-induced

  • alcoholic gastritis

- Chronic alcoholism
- Increased age
- Smoking
- Reflux of bile and alkaline secretions
- Autoimmune injury
- Hypersecretion
- Gastric resection
- Environmental factors including diet
- Helicobacter pylori infection

See also

- Helicobacter pylori–associated chronic gastritis

Videos

- Endoscopy of severe gastritis

References

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

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

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

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