Chronic gastritis

What is chronic gastritis?

Chronic gastritis means inflammation of the lining on the inside of the stomach. The inflammation damages the foveolar cells in the epithelium which prevents the stomach from functioning normally.

chronic gastritis

The stomach

The stomach is part of the gastrointestinal tract. When we eat, food enters the mouth and travels down the esophagus into the stomach. Once in the stomach, the food is mixed with a strong acid which breaks the food down into very small particles. This process is called digestion. The digested food particles are then either absorbed into the bloodstream or removed from the body as waste.

The tissue on the inner surface of the stomach is made up of specialized epithelial cells that form a barrier called the epithelium. The cells at the top of the epithelium are called foveolar cells and they protect the stomach from the strong acid used to break down food. Underneath the surface epithelium is a thin layer of tissue called the lamina propria which supports the surface cells. Together, the surface epithelium and lamina propria are called the mucosa.

Symptoms of chronic gastritis

The most common symptoms of chronic gastritis are abdominal pain (aching or burning) that is worse when the stomach is empty, nausea, bloating, and loss of appetite.

What causes chronic gastritis?

The most common cause of chronic gastritis is an infection of the stomach with a bacteria called Helicobacter pylori. Infection is more common in rural areas and in developing parts of the world.

Chronic gastritis can also be seen in people who have previously been treated for Helicobacter pylori. Chronic gastritis may persist for months or even years after successful treatment.

Other causes of chronic gastritis include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as Aspirin and Advil.
  • Excessive alcohol intake.
  • Bile reflux.
  • Autoimmune diseases.
How do pathologists make this diagnosis?

The diagnosis is usually made after a small sample of tissue is removed in a procedure called a biopsy. The tissue is then examined under a microscope by a pathologist. Your pathologist may order additional tests such as immunohistochemistry or special stains to look for Helicobacter pylori.

Chronic gastritis means that your pathologist saw an increased number of specialized immune cells called plasma cells within the lamina propria. Pathologists describe this change as chronic inflammation.

What to look for in your pathology report for chronic gastritis

Active gastritis

Active gastritis means that in addition to chronic inflammation, your pathologist saw ongoing tissue injury or damage. Another term for active gastritis is acute gastritis. In order to make this diagnosis, your pathologist must see specialized immune cells called neutrophils in the epithelium.

Active gastritis can be seen shortly after the injury or damage started or even later if you have not yet received treatment. The most common cause of active gastritis is infection with Helicobacter pylori. The neutrophils in the epithelium protect the body from bacteria but also damage the cells in the epithelium.

Active gastritis caused by Helicobacter pylori infection should be treated with antibiotics. If left untreated, Helicobacter infection can cause stomach ulcers. Untreated Helicobacter infection also increases the risk of developing cancer in the stomach.

Inactive gastritis

Some pathology reports will describe chronic gastritis as chronic inactive gastritis. The addition of the word inactive in the diagnosis means that no specialized immune cells called neutrophils were seen damaging the epithelium. Neutrophils are typically seen shortly after the injury starts and are a sign of ongoing damage (see Active gastritis above).

Intestinal metaplasia

Chronic gastritis that is not treated can damage the epithelium on the inside surface of the stomach. If the damage continues for many years, the normal foveolar cells in the epithelium are replaced by cells normally found in the small intestine (small bowel). This change is called intestinal metaplasia.

Intestinal metaplasia is a non-cancerous change that develops after many years of injury. While it in itself is not cancer, it increases the risk of developing a type of cancer called adenocarcinoma over time. It is recommended that people with intestinal metaplasia undergo a follow-up endoscopic examination of the stomach at least once every three years. Biopsies should be performed at each examination.


Dysplasia is a word pathologists use to describe an abnormal pattern of growth. Dysplasia can develop in patients who have had chronic gastritis for many years. It usually develops in areas of the stomach that already show intestinal metaplasia (see Intestinal metaplasia above).

Dysplasia is often described as low grade or high grade based on how abnormal the tissue looks when examined under the microscope. In low-grade dysplasia, the cells in the epithelium are darker than the normal, healthy cells. Pathologists describe these cells as hyperchromatic. In high-grade dysplasia, the normal organization of the epithelium is lost.

Like intestinal metaplasia, dysplasia is a non-cancerous change. However, it can turn into cancer called adenocarcinoma over time. The risk of cancer is higher with high-grade dysplasia. If your pathologist sees dysplasia in your biopsy it will be described in your report.

by Jason Wasserman MD PhD FRCPC, updated on December 23, 2020
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