Chronic "Nonspecific" Gastritis
A Clinicopathologic Term?
Author: André Mascarenhas Oliveira - Pathology ResidentMayo Clinic, Rochester, MN - USA
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Chronic "Nonspecific" Gastritis
Author: André Mascarenhas Oliveira - Pathology Resident |
The current classification of gastritis is imperfect and sometimes misleading for both clinicians and pathologists. However, we can divide it in four main groups: reactive gastropathies (erosive gastritis), chronic "nonspecific" gastritis, chronic gastritis with specific histology and acute gastritis due to infectious agents (table 1)1,2,3.
Among the chronic forms of gastritis, a group of inflammatory processes does not show any specific histologic pattern of inflammation that suggests a definite entity. This group, called chronic "nonspecific" gastritis, is characterized by an increased number of lymphocytes and plasma cells within the lamina propria (figure 1)1. It is divided in four subgroups based mainly on anatomic aspects (Table 1)1.
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Figure 1. (click here to zoom) Figure 1 - Chronic "Nonspecific" Gastritis (H&E, 160x). |
As the name indicates, this form of chronic gastritis involves predominantly the antrum and it is also known as "type B" gastritis. However, it can extend toward the upper portions of the stomach, causing a pangastritis. The association with H. pylori is very high and this Gram-negative bacteria is present in more than 90% of the cases. The occurrence of DAG is a strong marker for the development of duodenal and pyloric ulcers3 but an increased risk for gastric carcinomas has not been observed. Low grade malignant lymphoma of mucosa-associated lymphoid tissue (MALToma) has also been associated with H. pylori infection and DAG4.
Important characteristics of this type of chronic gastritis include its patchy gastric involvement and multiple foci of intestinal metaplasia. H. pylori has been observed in up to 100% of the cases5 but environmental and genetic factors have also been implicated1. MAG is associated with an increased risk for the development of proximal gastric ulcers and noncardiac gastric malignancies1.
Also known as "type A" gastritis, DCAG seems to be secondary to an autoimmune process. This type of gastritis involves predominantly the body and fundus of the stomach and shows prominent glandular atrophy of the oxyntic mucosa and intestinal metaplasia. DCAG is indistinguishable from MAG histologically and the information about the biopsy site is fundamental to differentiate between them. DCAG is not associated with H. pylori infection but an increased risk for pernicious anemia, gastric adenocarcinomas and gastric carcinoids has been observed6.
The diagnosis of reflux carditis relies on both the clinical history of gastroesophageal reflux disease and the exclusion of H. pylori infection or DAG because the latter two can involve the cardia1. Reflux "carditis" is clinically important because of its increased risk for the development of Barrett's esophagus and adenocarcinomas of the distal esophagus and gastric cardia. This type of chronic gastritis is not associated with gastric or duodenal ulcers.
Since the term chronic "nonspecific" gastritis includes a heterogeneous group of disorders with different etiologies and pathogeneses, good clinicopathologic correlation is essential for the accurate diagnosis of gastric biopsies and hence optimal patient management.
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Special Note About Gastric Cancer and H. pylori
H. pylori is not only associated with the development of gastric adenocarcinomas but also with the occurrence of MALTomas and gastric carcinoids1. |
1. Batts, KP. Chronic gastritis - where does Helicobacter pylori fit in? In: Conference on Chronic Gastritis; December, 1998; Mayo Clinic, Rochester, MN.
2. Correa, P. Chronic gastritis: a clinico-pathological classification. Am J Gastroenterol 1988; 83:504-9.
3. Yardley, JH and Paull, G. Campylobacter pylori: a newly recognized infectious agent in the gastrointestinal tract. Am J Surg Pathol 1988; 12 (suppl 1):88-89.
4. Isaacson, PG, Spencer, J. Invited review: malignant lymphoma of mucosa-associated lymphoid tissue. Histopathology 1987; 11: 445-462.
5. Correa, P. The epidemiology and pathogenesis of chronic gastritis: three etiologic entities. Front Gastrointest Res 1980; 6:98-108.
6. Solcia, E, Rindi, G, Fiocca, R, et al. Distinct patterns of chronic gastritis associated with carcinoid and cancer and their role in tumorigenesis. Yale J Biol Med 1992; 65: 793-804.
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