Difference between revisions of "Gastritis"

Gastritis
	Diagnosis in short
	; Chronic gastritis. H&E stain.
LM	acute: PMNs in the lamina propria or intraepithelial; (usual) chronic: cluster of plasma cells (mild), several clusters (moderate), +/-mucosal erosions (severe); lymphocytic: intraepithelial lymphocytes (25 lymphocytes/100 epithelial cells)
Subtypes	acute gastritis, chronic gastritis, focal acute gastritis (pill gastritis), lymphocytic gastritis
LM DDx	Helicobacter gastritis, collagenous gastritis, Crohn's disease, intestinal metaplasia of the stomach, gastric columnar dysplasia, gastric carcinoma
Stains	Diff-Quik -ve, cresyl violet -ve
IHC	Helicobacter -ve
Site	stomach
Associated Dx	intestinal metaplasia of the stomach - esp. in chronic gastritis
Clinical history	dyspepsia
Symptoms	upper abdominal pain
Prevalence	very common
Blood work	H. pylori -ve or previously +ve
Endoscopy	erythema
Prognosis	good
Other	neg. Helicobacter breath test
Clin. DDx	reactive gastropathy

Latest revision as of 00:06, 26 March 2024

Gastritis refers to an inflammatory process that affects the stomach.

There are several types of gastritis:

Chronic gastritis.
Helicobacter pylori gastritis.
Acute gastritis.
"Chemical gastritis" - not really a gastritis; the preferred term is reactive gastropathy.
Autoimmune gastritis.
Lymphocytic gastritis.
Collagenous gastritis.

This article gives an overview of causes of gastritis. It also deals with acute gastritis and the usual chronic gastritis without an apparent histologic cause.

Other forms of gastritis are dealt with in their own articles.

General

Very common.
A specific cause is uncommonly identified histologically.

Clinical:

Dyspepsia - esp. upper abdominal pain.

Etiology

Gastritis causes:^[1]

Infectious:
- H. pylori infection.
- Tuberculosis.
- Salmonellosis.
- CMV.
- EBV.
- Syphilis.
Endocrine-related:
- Pernicious anemia.
- Diabetes mellitus - gastric atony.
Trauma, e.g. NG tube.
Vascular, ischemia.
Autoimmune:
- Crohn's disease.
Toxins:
- Alcohol.
- Medications, especially NSAIDs.
- Uremia.
- Smoking (heavy).
Radiation.

Endoscopic appearance

Erythematous.

Microscopic

Inflammatory cells - see below.

Acute gastritis

AKA active gastritis.

Features:

Neutrophils - especially when intraepithelial.

Focal active gastritis

DDx:

Drugs,^[2] esp. NSAIDs.
Infectious.
Inflammatory bowel disease.

Chronic gastritis

Features:

Plasma cells (in lamina propria).
- Various criteria:
  1. Two plasma cells kissing, i.e. two plasma cells touching/overlapping.
  2. Three is a crowd, i.e. three plasma cells in close proximity.

Note:

Approximately 20% of cases with an inflamed cardia will have intestinal metaplasia.^[3]

Images

Moderate chronic gastritis - intermed. mag. (WC)
Moderate chronic gastritis - high mag. (WC)
Moderate chronic gastritis - very high mag. (WC)

Sydney criteria for gastritis

A bunch of pathologists in Sydney came-up with criteria... and these were revised in Houston.^[4]

Classification

Updated Sydney classification:^[4]

Feature	Non-atrophic Helicobacter	Atrophic Helicobacter	Autoimmune
Inflammation pattern	antral or diffuse	antrum & corpus, mild inflammation	corpus only
Atrophy & metaplasia	nil	atrophy present, metaplasia at incisura	corpus only

Notes:

Corpus = gastric body.
Incisura = angular incisure, incisura angularis (Latin) - notched transition point on lesser curvature of the stomach between pylorus and body.^[5]

Severity

The Sydney group suggests grading severity with the following language:^[4]

Mild.
Moderate.
Marked.

These terms are applied to the parameters described in a biopsy. The Sydney criteria lists H. pylori, neutrophils, mononuclear cells, antrum (atrophy), corpus (atrophy) and intestinal metaplasia. The paper that discusses this also give a visual analogue scale.

Parameters & Severity (adapted from Dixon et al.^[4]):

Feature	Mild	Moderate	Marked
H. pylori	few touching	many touching	piles
Neutrophils	few	bunches	crowded
Mononuclear cells	not touching	kissing	partying

Sign out

Minimal chronic inactive

STOMACH, BIOPSY: 
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MINIMAL CHRONIC INACTIVE INFLAMMATION. 
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. 
- NEGATIVE FOR INTESTINAL METAPLASIA. 
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Mild chronic inactive

Stomach, Antrum, Biopsy:
- Antral-type gastric mucosa with mild chronic inactive inflammation.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Stomach, Antrum, Biopsy:
- Antral-type gastric mucosa with mild focal chronic inactive inflammation, and mild focal gland tortousity without smooth muscle hyperplasia.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Block letters

STOMACH, BIOPSY: 
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MILD CHRONIC INACTIVE INFLAMMATION. 
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. 
- NEGATIVE FOR INTESTINAL METAPLASIA. 
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Moderate chronic inactive antrum with mild chronic inactive body

 STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC INACTIVE INFLAMMATION.
- BODY-TYPE GASTRIC MUCOSA WITH MILD CHRONIC INACTIVE INFLAMMATION.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Moderate chronic active

STOMACH, BIOPSY: 
- Body and antral-type gastric mucosa with moderate chronic active inflammation.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Block letters

STOMACH, BIOPSY: 
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION. 
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. 
- NEGATIVE FOR INTESTINAL METAPLASIA. 
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Severe active

Stomach, Biopsy: 
- Antral-type gastric mucosa with severe chronic active inflammation 
  with evidence of ulceration (fibrin, necro-inflammatory debris).
- NEGATIVE for Helicobacter-like organisms. 
- NEGATIVE for intestinal metaplasia. 
- NEGATIVE for dysplasia and NEGATIVE for malignancy. 

Comment:
Follow-up is suggested.

Sleeve gastrectomy

Partial Stomach, Sleeve Gastrectomy:
- Stomach wall with focal mild chronic inactive inflammation of the mucosa.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Alternate

Partial Stomach, Sleeve Gastrectomy:
	- Stomach wall with mild chronic inactive inflammation of the mucosa, otherwise 	  
          within normal limits.

Block letters

STOMACH, GREATER CURVATURE, SLEEVE GASTRECTOMY:
- STOMACH WALL WITH FOCAL MILD CHRONIC ACTIVE INFLAMMATION OF THE MUCOSA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro - inactive

The sections show gastric body type mucosa with small clusters of plasma cells. There are no intraepithelial neutrophils. Goblet cells are not identified. The epithelium matures normally to the surface. No Helicobacter organisms are seen.

References

↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 812-3. ISBN 0-7216-0187-1.
↑ Parfitt, JR.; Driman, DK. (Apr 2007). "Pathological effects of drugs on the gastrointestinal tract: a review.". Hum Pathol 38 (4): 527-36. doi:10.1016/j.humpath.2007.01.014. PMID 17367604.
↑ Voutilainen, M.; Färkkilä, M.; Mecklin, JP.; Juhola, M.; Sipponen, P. (Nov 1999). "Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease. The Central Finland Endoscopy Study Group.". Am J Gastroenterol 94 (11): 3175-80. doi:10.1111/j.1572-0241.1999.01513.x. PMID 10566710.
↑ ^4.0 ^4.1 ^4.2 ^4.3 Dixon MF, Genta RM, Yardley JH, Correa P (October 1996). "Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994". Am. J. Surg. Pathol. 20 (10): 1161-81. PMID 8827022. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=20&issue=10&spage=1161.
↑ http://en.wikipedia.org/wiki/Angular_incisure

[Ref_PBoD812-3-1] Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 812-3. ISBN 0-7216-0187-1.

[2] Parfitt, JR.; Driman, DK. (Apr 2007). "Pathological effects of drugs on the gastrointestinal tract: a review.". Hum Pathol 38 (4): 527-36. doi:10.1016/j.humpath.2007.01.014. PMID 17367604.

[pmid10566710-3] Voutilainen, M.; Färkkilä, M.; Mecklin, JP.; Juhola, M.; Sipponen, P. (Nov 1999). "Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease. The Central Finland Endoscopy Study Group.". Am J Gastroenterol 94 (11): 3175-80. doi:10.1111/j.1572-0241.1999.01513.x. PMID 10566710.

[pmid8827022-4] 4.0 ^4.1 ^4.2 ^4.3 Dixon MF, Genta RM, Yardley JH, Correa P (October 1996). "Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994". Am. J. Surg. Pathol. 20 (10): 1161-81. PMID 8827022. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=20&issue=10&spage=1161.

[5] ttp://en.wikipedia.org/wiki/Angular_incisure

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 {{ Infobox diagnosis
 | Name       = {{PAGENAME}}
-| Image      =
+| Image      = Chronic gastritis -- high mag.jpg
 | Width      =
-| Caption    =
+| Caption    = Chronic gastritis. [[H&E stain]].
 | Micro      = acute: [[PMN]]s in the lamina propria or intraepithelial; (usual) chronic: cluster of plasma cells (mild), several clusters (moderate), +/-mucosal erosions (severe); lymphocytic: intraepithelial lymphocytes (25 lymphocytes/100 epithelial cells)
 | Subtypes   = [[acute gastritis]], [[chronic gastritis]], focal acute gastritis (pill gastritis), [[lymphocytic gastritis]]
@@ Line 39: / Line 39: @@
 *[[Collagenous gastritis]].
-This article deals with ''[[acute gastritis]]'', the usual ''[[chronic gastritis]]'' without an apparent histologic cause, and ''lymphocytic gastritis''.
+This article gives an overview of causes of gastritis. It also deals with ''[[acute gastritis]]'' and the usual ''[[chronic gastritis]]'' without an apparent histologic cause.
+Other forms of gastritis are dealt with in their own articles.
 ==General==
 *Very common.
 *A specific cause is uncommonly identified histologically.
+Clinical:
+*Dyspepsia - esp. upper abdominal pain.
 ===Etiology===
@@ Line 52: / Line 57: @@
 **Salmonellosis.
 **[[CMV]].
+**[[EBV]].
+**[[Syphilis]].
 *Endocrine-related:
 **[[Pernicious anemia]].
@@ Line 69: / Line 76: @@
 *Erythematous.
-===Microscopic===
+==Microscopic==
 *Inflammatory cells - see below.
-====Acute gastritis====
+===Acute gastritis===
 *[[AKA]] ''active gastritis''.
@@ Line 78: / Line 85: @@
 *Neutrophils - especially when intraepithelial.
-=====Focal active gastritis=====
+====Focal active gastritis====
 DDx:
 #Drugs,<ref>{{Cite journal  | last1 = Parfitt | first1 = JR. | last2 = Driman | first2 = DK. | title = Pathological effects of drugs on the gastrointestinal tract: a review. | journal = Hum Pathol | volume = 38 | issue = 4 | pages = 527-36 | month = Apr | year = 2007 | doi = 10.1016/j.humpath.2007.01.014 | PMID = 17367604 }}
@@ Line 85: / Line 92: @@
 #Inflammatory bowel disease.
-====Chronic gastritis====
+===Chronic gastritis===
 Features:
 *[[Plasma cells]] (in lamina propria).
@@ Line 95: / Line 102: @@
 *Approximately 20% of cases with an inflamed cardia will have [[intestinal metaplasia]].<ref name=pmid10566710>{{Cite journal  | last1 = Voutilainen | first1 = M. | last2 = Färkkilä | first2 = M. | last3 = Mecklin | first3 = JP. | last4 = Juhola | first4 = M. | last5 = Sipponen | first5 = P. | title = Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease. The Central Finland Endoscopy Study Group. | journal = Am J Gastroenterol | volume = 94 | issue = 11 | pages = 3175-80 | month = Nov | year = 1999 | doi = 10.1111/j.1572-0241.1999.01513.x | PMID = 10566710 }}</ref>
-=====Lymphocytic gastritis=====
+====Images====
-======General======
+<gallery>
-The DDx is limited:
+Image: Chronic gastritis -- intermed mag.jpg | Moderate chronic gastritis - intermed. mag. (WC)
-#[[Helicobacter gastritis]].
+Image: Chronic gastritis -- high mag.jpg | Moderate chronic gastritis - high mag. (WC)
-#[[Celiac disease]].
+Image: Chronic gastritis -- very high mag.jpg | Moderate chronic gastritis - very high mag. (WC)
-#[[NSAID]]s.{{fact}}
+</gallery>
-#Idiopathic.
-#HIV/AIDS.
-======Microscopic======
-Features:<ref>El-Zimaity. 18 October 2010.</ref>
-*25 lymphocytes / 100 epithelial cells.
-====Sydney criteria for gastritis====
+===Sydney criteria for gastritis===
 A bunch of pathologists in Sydney came-up with criteria... and these were revised in Houston.<ref name=pmid8827022>{{cite journal |author=Dixon MF, Genta RM, Yardley JH, Correa P |title=Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994 |journal=Am. J. Surg. Pathol. |volume=20 |issue=10 |pages=1161-81 |year=1996 |month=October |pmid=8827022 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=20&issue=10&spage=1161}}</ref>
-=====Classification=====
+====Classification====
 Updated Sydney classification:<ref name=pmid8827022/>
 {| class="wikitable"
@@ Line 125: / Line 126: @@
 *''Incisura'' = angular incisure, incisura angularis (Latin) - notched transition point on lesser curvature of the stomach between pylorus and body.<ref>[http://en.wikipedia.org/wiki/Angular_incisure http://en.wikipedia.org/wiki/Angular_incisure]</ref>
-=====Severity=====
+====Severity====
 The Sydney group suggests grading severity with the following language:<ref name=pmid8827022/>
 *Mild.
@@ Line 157: / Line 158: @@
 |}
-===Sign out===
+==Sign out==
-====Minimal chronic inactive====
+===Minimal chronic inactive===
 <pre>
 STOMACH, BIOPSY:
 - BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MINIMAL CHRONIC INACTIVE INFLAMMATION.
-- NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
 - NEGATIVE FOR INTESTINAL METAPLASIA.
 - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 </pre>
-====Mild chronic inactive====
+===Mild chronic inactive===
+<pre>
+Stomach, Antrum, Biopsy:
+- Antral-type gastric mucosa with mild chronic inactive inflammation.
+- NEGATIVE for Helicobacter-like organisms.
+- NEGATIVE for intestinal metaplasia.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
+<pre>
+Stomach, Antrum, Biopsy:
+- Antral-type gastric mucosa with mild focal chronic inactive inflammation, and mild focal gland tortousity without smooth muscle hyperplasia.
+- NEGATIVE for Helicobacter-like organisms.
+- NEGATIVE for intestinal metaplasia.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
+====Block letters====
 <pre>
 STOMACH, BIOPSY:
 - BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MILD CHRONIC INACTIVE INFLAMMATION.
-- NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
 - NEGATIVE FOR INTESTINAL METAPLASIA.
+- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
+</pre>
+====Moderate chronic inactive antrum with mild chronic inactive body====
+<pre>
+ STOMACH, BIOPSY:
+- ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC INACTIVE INFLAMMATION.
+- BODY-TYPE GASTRIC MUCOSA WITH MILD CHRONIC INACTIVE INFLAMMATION.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
+- NEGATIVE FOR INTESTINAL METAPLASIA.
 - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 </pre>
 ====Moderate chronic active====
+<pre>
+STOMACH, BIOPSY:
+- Body and antral-type gastric mucosa with moderate chronic active inflammation.
+- NEGATIVE for Helicobacter-like organisms.
+- NEGATIVE for intestinal metaplasia.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
+=====Block letters=====
 <pre>
 STOMACH, BIOPSY:
 - BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION.
-- NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
 - NEGATIVE FOR INTESTINAL METAPLASIA.
+- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
+</pre>
+====Severe active====
+<pre>
+Stomach, Biopsy:
+- Antral-type gastric mucosa with severe chronic active inflammation
+  with evidence of ulceration (fibrin, necro-inflammatory debris).
+- NEGATIVE for Helicobacter-like organisms.
+- NEGATIVE for intestinal metaplasia.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+Comment:
+Follow-up is suggested.
+</pre>
+====Sleeve gastrectomy====
+<pre>
+Partial Stomach, Sleeve Gastrectomy:
+- Stomach wall with focal mild chronic inactive inflammation of the mucosa.
+- NEGATIVE for Helicobacter-like organisms.
+- NEGATIVE for intestinal metaplasia.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
+=====Alternate=====
+<pre>
+Partial Stomach, Sleeve Gastrectomy:
+	- Stomach wall with mild chronic inactive inflammation of the mucosa, otherwise
+          within normal limits.
+</pre>
+=====Block letters=====
+<pre>
+STOMACH, GREATER CURVATURE, SLEEVE GASTRECTOMY:
+- STOMACH WALL WITH FOCAL MILD CHRONIC ACTIVE INFLAMMATION OF THE MUCOSA.
+- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
+- NEGATIVE FOR INTESTINAL METAPLASIA.
 - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 </pre>

Difference between revisions of "Gastritis"

Latest revision as of 00:06, 26 March 2024

Contents

General

Etiology

Endoscopic appearance

Microscopic

Acute gastritis

Focal active gastritis

Chronic gastritis

Images

Sydney criteria for gastritis

Classification

Severity

Sign out

Minimal chronic inactive

Mild chronic inactive

Block letters

Moderate chronic inactive antrum with mild chronic inactive body

Moderate chronic active

Block letters

Severe active

Sleeve gastrectomy

Alternate

Block letters

Micro - inactive

See also

References

Navigation menu

Search

Gastritis
Diagnosis in short
Chronic gastritis. H&E stain.

LM	acute: PMNs in the lamina propria or intraepithelial; (usual) chronic: cluster of plasma cells (mild), several clusters (moderate), +/-mucosal erosions (severe); lymphocytic: intraepithelial lymphocytes (25 lymphocytes/100 epithelial cells)
Subtypes	acute gastritis, chronic gastritis, focal acute gastritis (pill gastritis), lymphocytic gastritis
LM DDx	Helicobacter gastritis, collagenous gastritis, Crohn's disease, intestinal metaplasia of the stomach, gastric columnar dysplasia, gastric carcinoma
Stains	Diff-Quik -ve, cresyl violet -ve
IHC	Helicobacter -ve
Site	stomach

Associated Dx	intestinal metaplasia of the stomach - esp. in chronic gastritis
Clinical history	dyspepsia
Symptoms	upper abdominal pain
Prevalence	very common
Blood work	H. pylori -ve or previously +ve
Endoscopy	erythema
Prognosis	good
Other	neg. Helicobacter breath test
Clin. DDx	reactive gastropathy