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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There are several types of gastritis:
There are several types of gastritis:
*[[Chronic gastritis]].
*[[Helicobacter pylori gastritis]].
*[[Helicobacter pylori gastritis]].
*[[Collagenous gastritis]].
*[[Acute gastritis]].
*[[Acute gastritis]].
*[[Chronic gastritis]].
*"Chemical gastritis" - not really a gastritis; the preferred term is ''[[reactive gastropathy]]''.
*[[Autoimmune gastritis]].
*[[Lymphocytic gastritis]].
*[[Lymphocytic gastritis]].
*"Chemical gastritis" - not really a gastritis; the preferred term is ''[[reactive gastropathy]]''.
*[[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.  


This article deals with ''acute gastritis'', the usual ''chronic gastritis'' without an apparent histologic cause, and ''lymphocytic gastritis''.
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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**Salmonellosis.
**Salmonellosis.
**[[CMV]].
**[[CMV]].
**[[EBV]].
**[[Syphilis]].
*Endocrine-related:
*Endocrine-related:
**[[Pernicious anemia]].
**[[Pernicious anemia]].
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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======
===Sydney criteria for gastritis===
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>
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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