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'''Gastritis''' refers to an inflammatory process that affect the [[stomach]].
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Chronic gastritis -- high mag.jpg
| Width      =
| 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]]
| 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 = dyspepsia
| Signs      =
| Symptoms  = upper abdominal pain
| 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]].


There are several types of gastritis:
There are several types of gastritis:
*[[Chronic gastritis]].
*[[Helicobacter pylori gastritis]].
*[[Helicobacter pylori gastritis]].
*[[Acute gastritis]].
*"Chemical gastritis" - not really a gastritis; the preferred term is ''[[reactive gastropathy]]''.
*[[Autoimmune gastritis]].
*[[Lymphocytic gastritis]].
*[[Collagenous gastritis]].
*[[Collagenous gastritis]].
*[[Acute gastritis]].
*[[Chronic 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:<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>
====Images====
<gallery>
Image: Chronic gastritis -- intermed mag.jpg | Moderate chronic gastritis - intermed. mag. (WC)
Image: Chronic gastritis -- high mag.jpg | Moderate chronic gastritis - high mag. (WC)
Image: Chronic gastritis -- very high mag.jpg | Moderate chronic gastritis - very high mag. (WC)
</gallery>
===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 HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
===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 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 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>
====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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