by Jason Wasserman MD PhD FRCPC
December 16, 2022
Chronic inactive gastritis means inflammation of the lining on the inside of the stomach. The inflammation damages the cells in the epithelium, the thin layer of tissue on the inside of the stomach which prevents the stomach from functioning normally.
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.
The most common cause of chronic inactive gastritis is an infection of the stomach with a bacteria called Helicobacter pylori. Infection is more common in rural areas and in the 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, and autoimmune diseases.
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. 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.
Chronic gastritis that is not treated can damage the epithelium that covers the inside of the stomach. If the damage continues for many years, the epithelium is replaced by cells normally found in a part of the gastrointestinal tract called the small intestine. This process is called intestinal metaplasia. If intestinal metaplasia is in the tissue sample, it will be described in your report.
Intestinal metaplasia is important because 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 below).
Most patients with chronic gastritis will not have dysplasia but when seen it will be described in your report. Pathologists divide dysplasia into low-grade dysplasia and high-grade dysplasia based on how abnormal the tissue looks when examined under the microscope.
Dysplasia is considered a precancerous change because it can turn into a type of stomach cancer called adenocarcinoma over time. The risk of cancer is higher with high-grade dysplasia.