Chronic gastritis

by Jason Wasserman MD PhD FRCPC
March 7, 2023

What does chronic gastritis mean?

Chronic gastritis means inflammation of the lining on the inside of the stomach. The inflammation prevents the stomach from functioning normally by damaging the specialized foveolar cells that cover the inside surface of the stomach.

What are the symptoms of chronic gastritis?

The most common symptoms of chronic gastritis are abdominal pain (aching or burning) which 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. 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. Your pathologist may order additional tests such as immunohistochemistry or special stains to look for Helicobacter pylori micro-organisms in the tissue sample.

What is the difference between inactive and active 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 chronic 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 chronic 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. Chronic 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.

What does intestinal metaplasia mean?

If left untreated, chronic gastritis can damage the foveolar cells that normally cover the inside surface of the stomach. If the damage continues for many years, the foveolar cells will be replaced by specialized cells normally found in a part of the digestive tract called the small intestine. This change is called 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, however, it does increase 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.

What does dysplasia mean?

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 based on how abnormal the tissue looks when examined under a microscope. Dysplasia is a precancerous change that increases the risk of developing a type of stomach cancer called adenocarcinoma over time. The risk of cancer is much greater when the dysplasia is described as high grade. Talk to your doctor if dysplasia is seen in your biopsy.

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