- chronic inflammation of the gastric mucosa
- mucosal atrophy
- epithelial metaplasia.
- commonly without erosions
Symptoms
Episodic pain
Nausea
Vomiting
Cx
Anaemia
Peptic Ulcer Disease
Gastric Carcinoma
Aetiology
Autoimmune gastritis
Bacterial gastritis
Chemical gastritis
Misc (Crohn's, radiotherapy)
Autoimmune Gastritis
- < 10% of chronic gastritis
- Autoantibodies produced to gastric parietal cells (90%) and intrinsic factor (60%)
- 10% have pernicious anaemia (where decreased intrinsic factor and decreased gastric acid production = decreased vit B12 absorption)
- Autoimmune associations with Hashimoto's thyrioditis and Addison's disease
Pathology
Commonly occurs in the gastric body or fundus
Immune-mediated destruction of the gastric glands
Chronic inflammation
Mucosal atrophy
Bacterial Gastritis
- Helicobacter Pylori makes up 90% of chronic antral gastritis
- Gram-negative rod
- No mucosal invasion
- Instead adheres to surface epithelium & produces urease
- Urease converts urea to ammonia, which buffers local gastric acid
- Increases risk of PUD and gastric cancer
Aetiology
Arises from chronic gastric mucosal injury
Alcohol
Smoking
Bile reflux
Ix
Commonly found in antrum (less so in the body/fundus)
Early findings:
hyperaemic, course, boggy (similar to early malignancy)
Later findings:
mucosa flattened and thin, after long-standing atrophy
Micro
1) Inflammatory aggregates - lymphocytes and plasma cells within lamina propria
2) Intestinal metaplasia
3) Glandular atrophy
4) Neutrophils within glandular epithelium
- H Pylori within syperficial mucosal layer
- Not found in areas of intestinal metaplasia (Absent in BarO and duodenal/pyloric metaplasia)
Cx
Long-standing
Epithelial atypia & dysplasia (pastricularly with atrophic gastritis & pernicious anemia)
Increase risk of cancer
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