Clinicopathological approach to gastritis

CHAIR OF INTERNAL MEDICINE WITH BASIS OF PULMONOLOGY

SUBJECT №12: «GASTRIC DYSPEPSIA AND CHRONIC GASTRITIS»

Amount of education hours: 2

CONSPECT OF THE LECTURE

The term gastritis should be reserved for histologically documented inflammation of the gastric mucosa. Gastritis is not the mucosal erythema seen during endoscopy and is not interchangeable with “dyspepsia.” The etiologic factors leading to gastritis are broad and heterogeneous. Gastritis has been classified based on time course (acute vs. chronic), histologic features, and anatomical distribution or proposed pathogenic mechanism.

Classification of Gastritis

I. Acute gastritis	II. Chronic atrophic gastritis
A. Acute H. pylori infection	A. Type A: Autoimmune, body-predominant
B. Other acute infectious gastritides	B. Type B: H. pylori –related, antral-predominant
1. Bacterial (other than H. pylori)	C. Indeterminant
2. Helicobacter helmanni	III. Uncommon Forms of Gastritis
3. Phlegmonous	A. Lymphocytic
4. Mycobacterial	B. Eosinophilic
5. Syphilitic	C. Crohn's disease
6. Viral	D. Sarcoidosis
7. Parasitic	E. Isolated granulomatous gastritis
8. Fungal

The correlation between the histologic findings of gastritis, the clinical picture of abdominal pain or dyspepsia, and endoscopic findings noted on gross inspection of the gastric mucosa is poor. Therefore, there is no typical clinical manifestation of gastritis.

CLINICOPATHOLOGICAL APPROACH TO GASTRITIS

Gastritis, simply defined as the inflammation of the gastric mucosa, is a condition, not a disease. With rare exceptions (e.g., lymphocytic gastritis and the extremely rare phlegmonous gastritis), inflammation of the gastric mucosa per se does not produce signs or symptoms; its complications do. Thus, clinicians rarely search for gastritis. In dyspeptic patients with indications for endoscopy, biopsies from the stomach are often obtained to determine the patient’s Helicobacter pylori status. If an appropriate set of gastric mucosal specimens is collected and properly examined, valuable information in addition to the often implicit question “is there H.pylori?” may be obtained: the type, severity, and distribution of gastritis and perhaps other causes of the gastric inflammation. This chapter is a discussion of useful strategies gastroenterologists and pathologists can use to optimize the diagnosis of gastric diseases.

Дата добавления: 2015-11-14