Gastritis: Difference between revisions

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→Acute gastritis: Threshold
 
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Inflammation of the [[stomach]]:
Inflammation of the [[stomach]]. If biopsy is at the esophagus, evaluate as '''[[gastroesophageal junction]]'''.
{{Comprehensiveness}}
==Microscopy evaluation==
==Microscopy evaluation==
[[File:Histopathology of mucosal plasma cell infiltrate in chronic gastritis.jpg|thumb|Mucosal plasma cell infiltrate in '''mild chronic gastritis'''.]]
Look for chronic or acute gastritis. If either is present, still look for the other.
===Chronic gastritis===
*'''Chronic gastritis'''<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachchronicgastritis.html|title=Stomach - Gastritis - Chronic gastritis|author=Elliot Weisenberg|website=PathologyOutlines}} Topic Completed: 1 August 2012. Minor changes: 31 August 2020</ref>
:*Presence of '''plasma cells''', '''lymphocytes''', and occasionally lymphoid '''follicles'''. Scattered single plasma cells and lymphocytes is normal, and the threshold is subjective, but one definition of chronic gastritis is when seeing chronic inflammation at 4x magnification (as increased dots separating glands)<ref>{{cite web|url=http://www.azpath.org/uploads/2/6/3/8/2638612/voltaggio_-_gastritis_presentation.pdf|title=Gastritis: A Pattern Based Approach|author=Lysandra Voltaggio, Johns Hopkins Department of Pathology|website=Arizona Society of Pathologists|date=2018-10-31}}</ref> Eosinophils and neutrophils may be present.
:*'''Reduced mucin''' in the cytoplasm
:*'''Enlargement''' of nuclei and nucleoi
:*'''Subnuclear vacuolation''' in antral glands or pits (which is PAS negative)
:*'''Intestinal metaplasia''': with partial replacement of the mucosa of the antrum and body with metaplastic goblet cells of intestinal morphology, absorptive cells and Paneth cells.
<gallery mode=packed heights=210>
File:Updated Sydney System for visual classification of gastritis.png|thumb|340px|Updated Sydney System for visual classification of gastritis.<ref name=Carrasco/>
File:Moderate superficial chronic gastritis.jpg|'''Moderate''' gastritis.
File:Histopathology of antral mucosa with atrophy.png|In '''intestinal metaplasia''' (seen at bottom of this antral mucosa), also look for '''atrophy''' as pictured.<ref name=Carrasco/><ref group=note>The combination of atrophy and gastritis (especially when deeper than submucosal) helps the clinician to potentially make a diagnosis of atrophic gastritis.</ref>
File:Histopathology of fundic mucosa with atrophy.png|Extensive atrophy of oxyntic glands in fundus/corpus causes '''pseudo-pyloric metaplasia'''.<ref name=Carrasco/>
</gallery>
When there is at least {{Moderate-begin}}mild or{{Moderate-end}} moderate gastritis, especially if relatively superficial, also evaluate as a [[stomach biopsy for Helicobacter pylori|stomach biopsy for '''Helicobacter pylori''']].
===Acute gastritis===
[[File:Histopathology of mild active gastritis, annotated.jpg|thumb|230px|Histopathology of '''mild active gastritis''', with intraepithelial neutrophils (white arrows) as well as in lamina propria (black arrows).]]
*'''Mild acute gastritis:'''<ref name=PathologyOutlinesAcute>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachacutegastritis.html|title=Stomach - Gastritis - Acute gastritis|author=Elliot Weisenberg|website=pathologyOutlines}} Topic Completed: 1 August 2012. Minor changes: 31 August 2020</ref>
*'''Mild acute gastritis:'''<ref name=PathologyOutlinesAcute>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachacutegastritis.html|title=Stomach - Gastritis - Acute gastritis|author=Elliot Weisenberg|website=pathologyOutlines}} Topic Completed: 1 August 2012. Minor changes: 31 August 2020</ref>
:*Modest '''edema''' of lamina propria
:*Modest '''edema''' of lamina propria
:*'''Vascular congestion'''
:*'''Vascular congestion'''
:*Scattered '''neutrophils'''
:*Scattered '''neutrophils'''. Even a few unequivocal neutrophils in the lamina propria or epithelium constitute gastritis.
:*Mucosal '''hemorrhage'''
:*Mucosal '''hemorrhage'''
:*Intact epithelium
:*Intact epithelium
<gallery mode=packed heights=210px>
File:Histopathology of early acute superficial gastritis.png|Early acute superficial gastritis: Marked neutrophilic infiltrates appear in the mucous neck region and lamina with a pit micoabscess.<ref name=Carrasco>{{cite journal| author=Carrasco G, Corvalan AH| title=Helicobacter pylori-Induced Chronic Gastritis and Assessing Risks for Gastric Cancer. | journal=Gastroenterol Res Pract | year= 2013 | volume= 2013 | issue=  | pages= 393015 | pmid=23983680 | doi=10.1155/2013/393015 | pmc=3745848 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23983680  }}<br>[https://www.researchgate.net/publication/256190376_Helicobacter_pylori-Induced_Chronic_Gastritis_and_Assessing_Risks_for_Gastric_Cancer Figures - available via license: Creative Commons Attribution 3.0 Unported]</ref>
</gallery>
*'''Moderate to severe acute gastritis''':<ref name=PathologyOutlinesAcute/>
*'''Moderate to severe acute gastritis''':<ref name=PathologyOutlinesAcute/>
:*'''Loss of superficial epithelium''' above the muscularis mucosa
:*'''Loss of superficial epithelium''' above the muscularis mucosa
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:*Fibrinopurulent luminal '''exudate'''
:*Fibrinopurulent luminal '''exudate'''
:*Nearby epithelium may show '''regenerative''' changes
:*Nearby epithelium may show '''regenerative''' changes
*'''Chronic gastritis'''<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachchronicgastritis.html|title=Stomach - Gastritis - Chronic gastritis|author=Elliot Weisenberg|website=PathologyOutlines}} Topic Completed: 1 August 2012. Minor changes: 31 August 2020</ref>
[[File:Histopathology of mucosal plasma cell infiltrate in chronic gastritis.jpg|thumb|Mucosal plasma cell infiltrate in mild chronic gastritis.]]
:*Presence of '''plasma cells''', '''lymphocytes''', and occasionally lymphoid '''follicles'''. Eosinophils and neutrophils may be present.
:*'''Reduced mucin''' in the cytoplasm
:*'''Enlargement''' of nuclei and nucleoi
:*'''Subnuclear vacuolation''' in antral glands or pits (which is PAS negative)
:*'''Intestinal metaplasia''': with partial replacement of the mucosa of the antrum and body with metaplastic goblet cells of intestinal morphology, absorptive cells and Paneth cells.


When gastritis is present, also evaluate as a [[stomach biopsy for Helicobacter pylori|stomach biopsy for '''Helicobacter pylori''']]
===Microscopy report===
*'''Mild and/or chronic gastritis''' and '''severity'''
:*{{Moderate-begin}}If present, state if positive or negative for '''''Helicobacter pylori''''' organisms.{{Moderate-end}}
Chronic gastritis without neutrophils is preferably also termed "inactive".


===Microscopy report===
Example:
Example:
{|class=wikitable
{|class=wikitable
| (Gastric, biopsy:) Mild chronic non-active gastritis, non-specific. Negative for ''Helicobacter pylori'' organisms on H&E slide.  
| {{Moderate-begin}}Stomach, biopsy:{{Moderate-end}}
*{{Moderate-begin}}Gastric antral/oxyntic mucosa with{{Moderate-end}} mild chronic {{Moderate-begin}}inactive{{Moderate-end}} gastritis{{Comprehensive-begin}}, non-specific{{Comprehensive-end}}
*{{Moderate-begin}}Negative for ''Helicobacter pylori'' organisms on H&E sections.{{Moderate-end}}
|}
|}
{{Bottom}}
{{Bottom}}

Latest revision as of 17:51, 25 July 2026

Author: Mikael Häggström [note 1]

Inflammation of the stomach. If biopsy is at the esophagus, evaluate as gastroesophageal junction.

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Microscopy evaluation

Mucosal plasma cell infiltrate in mild chronic gastritis.

Look for chronic or acute gastritis. If either is present, still look for the other.

Chronic gastritis

  • Chronic gastritis[1]
  • Presence of plasma cells, lymphocytes, and occasionally lymphoid follicles. Scattered single plasma cells and lymphocytes is normal, and the threshold is subjective, but one definition of chronic gastritis is when seeing chronic inflammation at 4x magnification (as increased dots separating glands)[2] Eosinophils and neutrophils may be present.
  • Reduced mucin in the cytoplasm
  • Enlargement of nuclei and nucleoi
  • Subnuclear vacuolation in antral glands or pits (which is PAS negative)
  • Intestinal metaplasia: with partial replacement of the mucosa of the antrum and body with metaplastic goblet cells of intestinal morphology, absorptive cells and Paneth cells.
  • Updated Sydney System for visual classification of gastritis.[3]
    Updated Sydney System for visual classification of gastritis.[3]
  • Moderate gastritis.
    Moderate gastritis.
  • In intestinal metaplasia (seen at bottom of this antral mucosa), also look for atrophy as pictured.[3][note 2]
    In intestinal metaplasia (seen at bottom of this antral mucosa), also look for atrophy as pictured.[3][note 2]
  • Extensive atrophy of oxyntic glands in fundus/corpus causes pseudo-pyloric metaplasia.[3]
    Extensive atrophy of oxyntic glands in fundus/corpus causes pseudo-pyloric metaplasia.[3]

When there is at least (mild or) moderate gastritis, especially if relatively superficial, also evaluate as a stomach biopsy for Helicobacter pylori.

Acute gastritis

Histopathology of mild active gastritis, with intraepithelial neutrophils (white arrows) as well as in lamina propria (black arrows).
  • Mild acute gastritis:[4]
  • Modest edema of lamina propria
  • Vascular congestion
  • Scattered neutrophils. Even a few unequivocal neutrophils in the lamina propria or epithelium constitute gastritis.
  • Mucosal hemorrhage
  • Intact epithelium
  • Early acute superficial gastritis: Marked neutrophilic infiltrates appear in the mucous neck region and lamina with a pit micoabscess.[3]
    Early acute superficial gastritis: Marked neutrophilic infiltrates appear in the mucous neck region and lamina with a pit micoabscess.[3]
  • Moderate to severe acute gastritis:[4]
  • Loss of superficial epithelium above the muscularis mucosa
  • Hemorrhage
  • Variable infiltrate with neutrophils
  • Fibrinopurulent luminal exudate
  • Nearby epithelium may show regenerative changes

Microscopy report

  • Mild and/or chronic gastritis and severity
  • (If present, state if positive or negative for Helicobacter pylori organisms.)

Chronic gastritis without neutrophils is preferably also termed "inactive".

Example:

(Stomach, biopsy:)
  • (Gastric antral/oxyntic mucosa with) mild chronic (inactive) gastritis((, non-specific))
  • (Negative for Helicobacter pylori organisms on H&E sections.)

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. ↑ The combination of atrophy and gastritis (especially when deeper than submucosal) helps the clinician to potentially make a diagnosis of atrophic gastritis.

Main page

References

  1. ↑ Elliot Weisenberg. Stomach - Gastritis - Chronic gastritis. PathologyOutlines. Topic Completed: 1 August 2012. Minor changes: 31 August 2020
  2. ↑ Lysandra Voltaggio, Johns Hopkins Department of Pathology (2018-10-31). Gastritis: A Pattern Based Approach. Arizona Society of Pathologists.
  3. ↑ 3.0 3.1 3.2 3.3 Carrasco G, Corvalan AH (2013). "Helicobacter pylori-Induced Chronic Gastritis and Assessing Risks for Gastric Cancer. ". Gastroenterol Res Pract 2013: 393015. doi:10.1155/2013/393015. PMID 23983680. PMC: 3745848. Archived from the original. . 
    Figures - available via license: Creative Commons Attribution 3.0 Unported
  4. ↑ 4.0 4.1 Elliot Weisenberg. Stomach - Gastritis - Acute gastritis. pathologyOutlines. Topic Completed: 1 August 2012. Minor changes: 31 August 2020

Image sources


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