Wednesday 21 January 2004
Definition: Chronic gastritis is an inflammatory condition of the gastric mucosa that may include structural alterations of the glandular compartment.
Sydney system of grading
|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.
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.
- antral-predominant non-atrophic gastritis
- non-atrophic pangastritis
- antrum-restricted atrophic gastritis
- corpus-restricted atrophic gastritis
- multifocal atrophic gastritis
- atrophic pangastritis
chronic active gastritis
- focal active gastritis
- focally enhanced gastritis
gastric graft-versus-host disease
- Helicobacter-associated 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)
- NSAID-induced gastritis
- alcoholic gastritis
Reﬂux of bile and alkaline secretions
Environmental factors including diet
Helicobacter pylori infection
Helicobacter pylori–associated chronic gastritis
Endoscopy of severe gastritis
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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