Chronic gastritis

Last author update: 1 August 2012
Last staff update: 18 May 2023

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PubMed Search: chronic gastritis[title]

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Chronic gastritis. website. Accessed September 21st, 2023.
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
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