Stomach
Gastritis
Chronic gastritis

Authors: Elliot Weisenberg, M.D. (see Authors page)

Revised: 22 November 2016, last major update August 2012

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: chronic gastritis[title]
Cite this page: Chronic gastritis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachchronicgastritis.html. Accessed December 4th, 2016.
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
Micro 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
Micro Images

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Intestinal metaplasia

Inflammatory infiltrate

Enterochromaffin cell hyperplasia