Difference between revisions of "Gastritis"

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Gastritis (view source)

Revision as of 01:43, 28 September 2013

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split-out from stomach - dis-disambig
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(split-out from stomach - dis-disambig)
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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =
| Width      =
| Caption    =
| 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
| Subtypes  = [[acute gastritis]], [[chronic gastritis]], focal acute gastritis (pill gastritis), [[lymphocytic gastritis]]
| LMDDx      = [[Helicobacter gastritis]], [[collagenous gastritis]], [[Crohn's disease]], [[intestinal metaplasia of the stomach]], [[gastric columnar dysplasia]], [[gastric carcinoma]]
| Stains    = [[Diff-Quik stain|Diff-Quik]] -ve, [[Cresyl violet stain|cresyl violet]] -ve
| IHC        = Helicobacter -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[stomach]]
| Assdx      = [[intestinal metaplasia of the stomach]] - esp. in chronic gastritis
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = very common
| Bloodwork  = H. pylori -ve or previously +ve
| Rads      =
| Endoscopy  = erythema
| Prognosis  = good
| Other      = neg. Helicobacter breath test
| ClinDDx    = [[reactive gastropathy]]
}}
'''Gastritis''' refers to an inflammatory process that affects the [[stomach]].
'''Gastritis''' refers to an inflammatory process that affects the [[stomach]].


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*[[Chronic gastritis]].
*[[Chronic gastritis]].


This article deals with ''acute gastritis'' and ''chronic gastritis'' without an apparent histologic cause.
==General==
*Very common.
*A specific cause is uncommonly identified histologically.
===Etiology===
Gastritis causes:<ref name=Ref_PBoD812-3>{{Ref PBoD|812-3}}</ref>
*Infectious:
**[[H. pylori]] infection.
**[[Tuberculosis]].
**Salmonellosis.
**[[CMV]].
*Endocrine-related:
**[[Pernicious anemia]].
**[[Diabetes mellitus]] - gastric atony.
*Trauma, e.g. NG tube.
*Vascular, ischemia.
*Autoimmune:
**[[Crohn's disease]].
*Toxins:
**[[Alcohol]].
**Medications, especially [[NSAID]]s.
**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,<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 }}
</ref> esp. [[NSAIDs]].
#Infectious.
#Inflammatory bowel disease.
====Chronic gastritis====
Features:
*[[Plasma cells]] (in lamina propria).
**Various criteria:
**#Two plasma cells kissing, i.e. two plasma cells touching/overlapping.
**#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]].<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=====
======General======
The DDx is limited:
#[[Helicobacter gastritis]].
#[[Celiac disease]].
#[[NSAID]]s.{{fact}}
#Idiopathic.
#HIV/AIDS.
======Microscopic======
Features:<ref>El-Zimaity. 18 October 2010.</ref>
*25 lymphocytes / 100 epithelial cells.
====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=====
Updated Sydney classification:<ref name=pmid8827022/>
{| class="wikitable"
| '''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.<ref>[http://en.wikipedia.org/wiki/Angular_incisure http://en.wikipedia.org/wiki/Angular_incisure]</ref>
=====Severity=====
The Sydney group suggests grading severity with the following language:<ref name=pmid8827022/>
*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.<ref name=pmid8827022/>):
{| class="wikitable sortable"
! 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====
<pre>
STOMACH, BIOPSY:
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MINIMAL CHRONIC INACTIVE INFLAMMATION.
- NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
====Mild chronic inactive====
<pre>
STOMACH, BIOPSY:
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MILD CHRONIC INACTIVE INFLAMMATION.
- NEGATIVE FOR HELICOBACTOR-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 HELICOBACTOR-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
====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.
==See also==
*[[Helicobacter pylori gastritis]].
*[[Collagenous gastritis]].
==References==
{{Reflist|2}}
[[Category:Stomach]]
[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]
Michael
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