Chronic gastritis

by Jason Wasserman MD PhD FRCPC
June 9, 2022

About this article: This article was created by doctors to help you read and understand your pathology report for chronic gastritis. If you have any questions about this article or your pathology report, please contact us.

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.

What are the 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. Pathologists often describe this condition as Helicobacter gastritis. 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 micro-organisms in the tissue sample.

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.

chronic gastritis

Active versus inactive chronic gastritis

Pathologists divide chronic gastritis into active and inactive. 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 mucosa. In contrast, inactive gastritis means that no neutrophils were seen in the mucosa.

Most pathology reports will further divide active gastritis into mild, moderate, or severe based on the type of damage being caused by the neutrophils.

  • Mildly active: Neutrophils are seen in the lamina propria and some may be seen in between epithelial cells. Pathologists sometimes use the term cryptitis to describe this type of activity.
  • Moderately active: As with mild activity, neutrophils are seen in the lamina propria. In addition, groups of neutrophils are usually seen inside the glands. Pathologists use the term crypt abscess to describe this type of activity.
  • Severely active: At this level of activity the epithelium that normally covers the inside surface of the stomach has been lost. Pathologists use the term ulcer or ulceration to describe this change. An ulcer in the stomach means that the tissue that is normally found under the epithelium is exposed to the inside environment of the stomach. If not treated, an ulcer can lead to bleeding in the stomach.

The most common cause of active gastritis is infection with Helicobacter pylori. The neutrophils in the mucosa 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.

Intestinal metaplasia

Chronic gastritis that is not treated can damage the foveolar epithelium. If the damage continues for many years, a new type of epithelium similar to the epithelium normally found in the small intestine slowly replaces the foveolar epithelium.

The change from foveolar epithelium to small intestinal epithelium is an example of metaplasia and pathologists describe the specific type of metaplasia that takes place in the stomach as intestinal metaplasia. If your pathologist sees intestinal metaplasia in the tissue sample, it will be described in your report.

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 stomach cancer called adenocarcinoma over time. The risk is higher when another type of change called dysplasia is also seen (see Dysplasia below).


Dysplasia is a word pathologists use to describe an abnormal pattern of growth. Like intestinal metaplasia, dysplasia can develop in patients who have had chronic gastritis for many years.

Most patients with chronic gastritis will not have dysplasia but when seen it will be described in your report. Pathologists divide dysplasia into low and high grades based on how abnormal the tissue looks when examined under the microscope.

Dysplasia is a non-cancerous change. However, it is considered a precancerous condition because it increases the risk of developing a type of stomach cancer called adenocarcinoma over time. The risk of cancer is higher with high-grade dysplasia.

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