Stomach
Gastritis
Chronic gastritis
Author: Elliot Weisenberg, M.D.
Last author update: 1 August 2012
Last staff update: 18 May 2023
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: chronic gastritis[title]
Cite this page: Weisenberg E. Chronic gastritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachchronicgastritis.html. Accessed April 25th, 2024.
Definition / general
- Chronic mucosal inflammatory changes leading to mucosal atrophy and epithelial metaplasia, usually without erosions
- Most cases are type B or non-autoimmune gastritis
- Associated with chronic Helicobacter pylori infection (Am J Surg Pathol 2006;30:242), toxins (alcohol, tobacco), reflux of bilious duodenal secretions (post-antrectomy or other), obstruction (bezoars, atony), radiation
- Incidence increases with age; in Europe / Japan, affects 50% at age 60+
- Histology does not correlate well with symptoms
- Superficial chronic gastritis:
- Inflammation confined largely to mucosa occupied by gastric pits
Microscopic (histologic) description
- Plasma cells, lymphocytes, occasional lymphoid follicles
- May have eosinophils and neutrophils also
- May have reduced cytoplasmic mucin, reactive epithelial changes (nuclear and nucleolar enlargement)
- May have subnuclear vacuolation in antral glands or pits (PAS negative), probably represents degenerative response to cell injury
- Intestinal metaplasia: affects antral and body / fundic mucosa, with partial replacement by metaplastic goblet cells of intestinal morphology, absorptive cells and Paneth cells; extensive if involves 25% of biopsy tissue
- Immunophenotypically distinct from intestinal metaplasia of GE junction or Barrett's esophagus (Am J Surg Pathol 2001;25:87)
- Complete intestinal metaplasia: mucosal pattern resembles small bowel epithelium with goblet and absorptive cells, villi and crypts; sialomucins predominate
- Incomplete intestinal metaplasia: no absorptive cells, columnar cells resemble gastric foveolar cells; neutral mucins and sulfomucins are present
