Gastritis

Gastritis


GASTRITIS

Autoimmune (Type A) gastritis

H. pylori (Type B) gastritis (90%)

  • Associations – Autoimmune disease; thyroiditis, diabetes mellitus, Graves disease
  • Antrum not affected
  • Antibodies to parietal cells components (H+,K+-ATPase, or proton pump, intrinsic factor) à Hypochlorhydria à G cell hyperplasia à hypergastrinemia
  • Intrinsic factor deficiency à pernicious anemia
  • Microadenoma of enterochromaffin like (ECL) à gastric adenocarcinoma, carcinoid
  • Reduced serum pepsinogen I concentration

Histology

  • Inflammatory infiltrates – Lymphocytes, Macrophages
  • Diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus
  • Associations – Low socioeconomic status, poverty, residence in rural areas
  • Most commonly affects the antrum
  • (Normal or) Increased acid production à peptic ulcer disease
  • CagA expressing strains à effectively colonize the gastric body à Multifocal atrophic gastritis à decreased acid production, Intestinal metaplasia à gastric adenocarcinoma, MALToma
  • Hypergastrinemia uncommon

Histology

  • Intraepithelial neutrophils and subepithelial plasma cells are characteristic
  • Typically a patchy process
Exam Question
 
  • Increased production of macrocytic red blood cells would mostly likely be associated with chronic gastritis (Type A) resulting from autoimmune destruction of parietal cells.
  • A patient of peptic ulcer disease, when investigated endoscopically showed chronic antral gastritis. Warthin Starry Stain will be able to stain the specimen.
  • Type B gastritis:It is called as antral predominant gastritis as antrum is involved predominantly. However, it is misnomer as the inflammatory process may progress to body and fundus and causing pangastritis.
  • Autoimmune gastritis is less common of the two forms and is characterized by :- Presence of antibodies against parietal cells and intrinsic factor and Involvement of body and fundus with sparing of antrum.
  • Endoscopic biopsy from a case of H.pylori related duodenal ulcer is most likely to reveal Antral predominant Gastritis.
  • Atrophic Gastritis is a predisposing factors for gastric carcinoma.
  • Erosive gastritis commonly occurs at Body and Fundus.
  • H. pylori causes Type B gastritis.
  • Most important side effect of aspirin is Gastritis.
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