Crohn gastritis

Definition: Crohn disease patients with gastric involvement often also have duodenal disease.

Images

 Crohn disease with gastric involvement

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Endoscopic abnormalities, including mucosal nodularity with cobble stoning, aphthous ulcers, linear or serpiginous ulcers, thickened antral folds, antral narrowing, hypoperistalsis, and duodenal strictures, are present in patients with severe gastric Crohn disease.

The diagnosis of gastric Crohn disease is easy in the presence of florid disease and in the setting of disease elsewhere in the gut.

However, the diagnosis is more difficult if gastric involvement is the first disease manifestation.

Well-developed gastric Crohn disease shows patchy, focal inflammation associated with acute inflammation in the pits (pit abscesses) or glands.

Neural hyperplasia and lymphoid aggregates may bepresent.

A prominent lymphoplasmacytic infiltrate often surrounds the granulomas, contrasting with both sarcoid and isolated granulomatous gastritis, which tend to lack the associated nonspecific inflammation.

Synopsis

 Glandular epithelium showing regenerative changes.
 The surrounding lamina propria is infiltrated with lymphocytes and plasma cells.
 possible granuloma in the gastric mucosa

• The granuloma is surrounded by a cuffing of mononuclear cells.
• No evidence of caseous necrosis or foreign bodies is seen.

 Higher magnification of the granuloma demonstrates the presence of several giant cells as well as epithelioid histiocytes.

Synopsis

 acute gastritis

• focal acute gastritis
  • focal gland injury with neutrophils
    • focal gastric glandular abscesses
    • focal gastric glandulitis

• • focal concomitant eosinophilic infiltrates

 granulomatous gastritis

• tuberculoid granuloma

References

 Wright CL, Riddell RH. Histology of the stomach and duodenum in Crohn’s disease. Am J Surg Pathol. 1998 Apr;22(4):383-90. PMID: 9537465