Gastritis - Stomach -

This article will help you read and understand your pathology report for gastritis of the stomach.

by Jason Wasserman, MD PhD FRCPC, reviewed and updated on January 2, 2020

stomach gastritis

Quick facts:
  • Gastritis is a word pathologists use to describe a pattern of injury that involves the tissue on the inside of the stomach.
  • It can be caused by infection, bleeding, medications, or inflammation.
  • Pathologists often describe gastritis as active, chronic, or erosive.
  • The most common cause is infection of the stomach by a bacteria called Helicobacter.
The anatomy and histology of 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 blood stream 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 mucosa.

What is gastritis?

Gastritis is a word pathologists use to describe a type of injury involving the epithelium on the inside of the stomach. It can be caused by anything that injures or damages the epithelium. Common causes include infection, bleeding, medications, and inflammation.

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. Pathologists often describe gastritis as active, chronic, or erosive based on how the tissue looks when examined under the microscope (see sections below for more information). This description will help your doctors determine the cause. Your pathologist may order additional tests such as immunohistochemistry or special stains to look for bacteria that may be causing the gastritis.

Types of gastritis

Active gastritis

Active gastritis means that 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 is infection of the stomach with a bacteria called Helicobacter pylori. The neutrophils in the epithelium protect the body from the 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.

Chronic gastritis

Chronic gastritis means that your pathologist saw an increased number of specialized immune cells called plasma cells within the lamina propria. Plasma cells mean that the injury in the stomach may have started months or even years earlier. Pathologists describe this change as chronic inflammation.

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).

Chronic gastritis is usually seen weeks or months after the original cause for the injury started. Like active gastritis, the most common cause is infection of the stomach with a bacteria called Helicobacter pylori. However, unlike active gastritis, your pathologist will not see any neutrophils in chronic gastritis. Other causes include alcohol and non-steroidal anti-inflammatory drugs (NSAIDS) such as Aspirin and Advil. Autoimmune diseases in which the body’s own immune cells attack normal, healthy cells in the stomach can also cause chronic gastritis.

The most common cause of chronic gastritis is infection with Helicobacter pylori. However, if your pathologist does not see Helicobacter in the tissue sample from your stomach, your doctor should consider other potential causes. Make sure to tell your doctor about any medications you are taking or have recently stopped.

Chronic active gastritis

Chronic active gastritis means that your pathologist saw features of both chronic gastritis and active gastritis when the tissue sample was examined under the microscope (see Active gastritis and Chronic gastritis above for more details). Usually that means that both neutrophils and plasma cells were seen in the epithelium on the inner surface of the stomach.

The most common cause of chronic active gastritis is infection with Helicobacter pylori. However, if your pathologist does not see Helicobacter in the tissue sample from your stomach, your doctor should consider other potential causes. Make sure to tell your doctor about any medications you are taking or have recently stopped.

Erosive gastritis

Erosive gastritis means a complete loss, or erosion, of the surface epithelium normally found on the inner surface of the stomach. The loss of epithelium leaves the tissue below exposed to the acids inside the stomach. This can lead to pain and bleeding.

Erosive gastritis can be caused by prolonged use of non-steroidal anti-inflammatory drugs (NSAIDS) such as Aspirin and Advil, alcohol, iron pills, stress, physical injury, chemotherapy, or radiation therapy to the stomach.

Another name for erosive gastritis is hemorrhagic gastritis. Hemorrhagic gastritis means that your pathologist saw blood filling the mucosa.

Erosive gastritis is a serious medical condition that needs to be treated quickly to prevent further injury to the stomach. Your doctors will attempt to determine the cause of the erosive gastritis. Make sure to tell your doctors about any medications you are taking or have recently stopped.

Helicobacter gastritis

Helicobacter gastritis is a type of gastritis caused by infection with the bacteria Helicobacter pylori. It is the most common cause of gastritis in Western countries although it is becoming increasingly common in other parts of the world as well.

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.

Other conditions associated with gastritis

Intestinal metaplasia

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 for 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

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 cells the normal organization of the epithelium is lost.

Like intestinal metaplasia, dysplasia is a non-cancerous change. However, it can turn into a 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.

 

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