Difference between revisions of "Gastritis"

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Gastritis (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Chronic gastritis -- high mag.jpg
| Width      =
| 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)
| 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]]
| Subtypes  = [[acute gastritis]], [[chronic gastritis]], focal acute gastritis (pill gastritis), [[lymphocytic gastritis]]
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| Assdx      = [[intestinal metaplasia of the stomach]] - esp. in chronic gastritis
| Assdx      = [[intestinal metaplasia of the stomach]] - esp. in chronic gastritis
| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx = dyspepsia
| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  = upper abdominal pain
| Prevalence = very common
| Prevalence = very common
| Bloodwork  = H. pylori -ve or previously +ve
| Bloodwork  = H. pylori -ve or previously +ve
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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 deals with ''acute gastritis'' and ''chronic gastritis'' without an apparent histologic cause.
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==
==General==
*Very common.
*Very common.
*A specific cause is uncommonly identified histologically.
*A specific cause is uncommonly identified histologically.
Clinical:
*Dyspepsia - esp. upper abdominal pain.


===Etiology===
===Etiology===
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*Erythematous.
*Erythematous.


===Microscopic===
==Microscopic==
*Inflammatory cells - see below.
*Inflammatory cells - see below.


====Acute gastritis====
===Acute gastritis===
*[[AKA]] ''active gastritis''.
*[[AKA]] ''active gastritis''.


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*Neutrophils - especially when intraepithelial.
*Neutrophils - especially when intraepithelial.


=====Focal active gastritis=====
====Focal active gastritis====
DDx:
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 }}
#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 }}
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#Inflammatory bowel disease.
#Inflammatory bowel disease.


====Chronic gastritis====
===Chronic gastritis===
Features:
Features:
*[[Plasma cells]] (in lamina propria).
*[[Plasma cells]] (in lamina propria).
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*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>
*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>
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/>
Updated Sydney classification:<ref name=pmid8827022/>
{| class="wikitable"
{| class="wikitable"
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*''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>
*''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/>
The Sydney group suggests grading severity with the following language:<ref name=pmid8827022/>
*Mild.
*Mild.
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|}
|}


===Sign out===
==Sign out==
====Minimal chronic inactive====
===Minimal chronic inactive===
<pre>
<pre>
STOMACH, BIOPSY:  
STOMACH, BIOPSY:  
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MINIMAL CHRONIC INACTIVE INFLAMMATION.  
- 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 INTESTINAL METAPLASIA.  
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
</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>
<pre>
STOMACH, BIOPSY:  
STOMACH, BIOPSY:  
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MILD CHRONIC INACTIVE INFLAMMATION.  
- 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 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.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


====Moderate chronic active====
====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>
<pre>
STOMACH, BIOPSY:  
STOMACH, BIOPSY:  
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION.  
- 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 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.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
</pre>
Michael
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