Lymphocytic gastritis is characterized by the presence of large numbers of mature lymphocytes infiltrating the surface and foveolar epithelium.

The increase in intraepithelial lymphocytes can be associated with marked chronic inflammatory cell infiltration of the lamina propria, activity, and focal erosions, or at the other extreme, only a minor increase in chronic inflammatory cells with no activity.

The histological picture is readily distinguished from ordinary H. pylori-associated chronic gastritis. In the latter one finds four to seven lymphocytes per 100 epithelial cells, whereas 10 times this number can be found in lymphocytic gastritis.

Most cases have counts between 25 and 40 lymphocytes per 100 epithelial cells, the diagnostic threshold for lymphocytic gastritis being generally taken as being greater than 25 intraepithelial lymphocytes (IELs) per 100 cells.

The IELs are almost exclusively T-lymphocytes and the great majority (around 90%) are CD8+ suppressor cells. The condition is frequently associated with the endoscopic entity varioliform gastritis, which is characterized by nodular and eroded lesions running along the gastric rugae in the corpus while in some cases the endoscopic and histological appearances overlap with those of Menetrier disease.

An association between lymphocytic gastritis and celiac disease is becoming increasingly recognized.

Etiology

 celiac disease (33%)
 Helicobacter pylori gastritis (19%)
 varioliform gastritis
 inflammatory polyp
 Crohn's disease
 human immunodeficiency virus infection
 lymphoma
 esophageal carcinoma
 lymphocytic gastroenterocolitis

References

 Wu TT, Hamilton SR. Lymphocytic gastritis: association with etiology and topology. Am J Surg Pathol. 1999 Feb;23(2):153-8. PMID: #9989841#