Gastrite cronica: comprendere il referto della patologia

Redattore di sezione: David Driman MBChB FRCPC
13 novembre 2026

Gastrite cronica is long-lasting inflammation of the stomach lining, and it is not cancer. It is one of the most common findings on stomach biopsies, and worldwide, its most common cause is infection with the bacterium Helicobacter pylori.

Chronic gastritis describes what the pathologist sees under the microscope rather than a single disease. Your report will usually add more detail, such as whether the gastritis is active or inactive, how severe it is, and whether H. pylori bacteria were seen. This article explains what chronic gastritis means, what can cause it, and what each part of your pathology report describes.

Cosa significa gastrite cronica?

Chronic gastritis means there is infiammazione cronica in the stomach lining, called the membrana mucosa. Under the microscope, the pathologist sees more immune cells called linfociti and plasmacellule than are normally present. These cells collect in the lamina propria, the tissue that supports the stomach’s glands, when inflammation has been present for weeks or longer.

Chronic active gastritis and chronic inactive gastritis

Pathologists divide chronic gastritis into two patterns based on whether neutrofili are present. Neutrophils are immune cells that attack the stomach lining when there is ongoing injury, such as an active infection.

Chronic active gastritis. Neutrophils are present along with lymphocytes and plasma cells, which usually indicates current injury, most often an active H. pylori infection. This pattern is explained in more detail in the article on gastrite cronica attiva.
Chronic inactive gastritis. Neutrophils are not present. This pattern is common after H. pylori has been treated, and mild gastrite cronica inattiva often has no specific cause.

The word active does not mean the inflammation is new, and it does not mean the same thing as acute. Both patterns describe long-lasting inflammation, and the only difference is whether neutrophils are present.

Quali sono le cause della gastrite cronica?

Several conditions can cause chronic gastritis. Your doctor will use the other findings in your report and your medical history to work out which one applies to you.

Infezione da Helicobacter pylori. H. pylori is the most common cause of chronic gastritis. The bacteria live on the surface of the stomach lining and cause inflammation that can last for many years if not treated. Pathologists often call this Gastrite da Helicobacter.
Past Helicobacter pylori infection. Dopo H. pylori is treated, the lymphocytes and plasma cells can remain in the stomach lining for months or even several years.
Gastrite autoimmune. In this condition, the immune system attacks the acid-producing cells in the upper part of the stomach. Over time, it can lead to gastrite atrofica and low vitamin B12 levels.
Medications, alcohol, and bile. Anti-inflammatory medications such as ibuprofen and naproxen, alcohol, and bile that flows back into the stomach more often cause a different pattern of injury called gastropatia reattiva. However, they can also be associated with mild chronic inflammation in the stomach lining.
Cause meno comuni. Rarer causes include lymphocytic gastritis, which can be linked to celiachiae Malattia di Crohn.

Quali sono i sintomi della gastrite cronica?

Many people with chronic gastritis have no symptoms. When symptoms occur, they can include a burning or aching pain in the upper abdomen, nausea, bloating, and loss of appetite. Some people are found to have chronic gastritis in biopsies taken during an endoscopy done for another reason, such as heartburn or anemia. Chronic active gastritis caused by H. pylori può portare a un ulcera gastrica, which may cause pain or bleeding.

Come viene fatta la diagnosi?

A pathologist diagnoses chronic gastritis after l'esame di biopsie of the stomach lining under a microscope. The biopsies are usually taken during an upper endoscopy. Ideally, biopsies are taken from both the lower part of the stomach, called the antro, and the upper part, called the stile di vita.

Under the microscope, the pathologist assesses the type and amount of inflammation, whether neutrophils are present, and whether H. pylori can be seen. The pathologist also looks for other changes in the lining, such as atrophy, intestinal metaplasia, and dysplasia.

Severity and activity

Many pathologists describe chronic gastritis using the Updated Sydney System, an international system for describing gastritis. In this system, chronic inflammation and neutrophil activity are each graded as mild, moderate, or severe. Your report may give separate grades for the antrum and the body of the stomach.

Infiammazione cronica. This grade describes how many lymphocytes and plasma cells are present. When no cause is found, mild chronic gastritis is often considered a nonspecific finding of little significance.
Attività. This grade describes how many neutrophils are present and how much damage they are causing. In severe activity, neutrophils may fill the glands, forming small collections called pit ascessi. If the surface lining is lost, the pathologist may describe an erosion or an ulcera.

Helicobacter pylori

Il tuo rapporto dirà se Helicobacter pylori bacteria were seen in the biopsies. Pathologists can often see the bacteria on routine slides, but they may use a macchia speciale or immunoistochimica to look for small numbers of bacteria.

Un risultato negativo della biopsia non significa sempre H. pylori is absent. Proton pump inhibitors, recent antibiotics, and biopsies from only one part of the stomach can all cause the bacteria to be missed. For this reason, your doctor may recommend a breath test or stool test. Learn more about testare per H. pylori.

Altri risultati del rapporto

Long-lasting gastritis, especially H. pylori-related gastritis, can change the stomach lining over many years. Your report will usually say whether these changes were seen, because they affect your long-term risk and whether you need follow-up.

Atrofia. Atrofia significa che alcune delle ghiandole normali dello stomaco sono andate perse. Scopri di più su gastrite atrofica.
Metaplasia intestinale. Intestinal metaplasia means the normal stomach lining has been replaced by cells that look like the lining of the intestine. It slightly increases the long-term risk of stomach cancer, as explained in the article on metaplasia intestinale dello stomaco.
Displasia. La displasia è un cambiamento precanceroso nelle cellule di rivestimento. La maggior parte dei referti dirà "negativo per displasia". Scopri di più displasia gastrica.

Does chronic gastritis increase my risk of stomach cancer?

di un noleggio H. pylori infection is the most important cause of stomach cancer worldwide. The risk comes mainly from the gradual development of atrophy and intestinal metaplasia over many years. Treating H. pylori lowers this risk, and chronic gastritis without atrophy, intestinal metaplasia, or dysplasia does not usually need regular follow-up for cancro allo stomaco.

Cosa succede dopo la diagnosi?

What happens after chronic gastritis is found depends mostly on the cause and on the other findings in your report.

Trattamento dell'Helicobacter pylori. If H. pylori is found, it is treated with a combination of antibiotics and a medication that lowers stomach acid.
Confirming treatment worked. After treatment, your doctor may confirm that the infection is gone with a breath or stool test done at least 4 weeks later. Proton pump inhibitors are usually stopped for at least 2 weeks before the test.
Testing when the biopsy is negative. If the gastritis is moderate or severe but no bacteria were seen, your doctor may still recommend a breath or stool test.
Alla ricerca di altre cause. A seconda del quadro infiammatorio, il medico potrebbe verificare la presenza di gastrite autoimmune, rivedere la terapia farmacologica in corso o effettuare test per la celiachia.
Endoscopia di controllo. Most people with chronic gastritis do not need follow-up endoscopies. Follow-up is recommended mainly for people who also have extensive atrophy, intestinal metaplasia with other risk factors, or dysplasia.

Domande da porre al medico

Is my gastritis active or inactive?
L'infiammazione era lieve, moderata o grave?
Mi sono state prelevate biopsie sia dall'antro che dal corpo dello stomaco?
Era H. pylori seen in my biopsies?
Ho bisogno di cure per H. pylori, and how will we confirm it worked?
Sono state riscontrate atrofia, metaplasia intestinale o displasia?
È possibile che qualcuno dei miei farmaci stia influenzando il mio stomaco?
Devo sottopormi a un'endoscopia di controllo?