A CLINICOPATHOLOGICAL STUDY OF 42 PATIENTS WITH GRANULOMATOUS GASTRITIS - IS THERE REALLY AN IDIOPATHIC GRANULOMATOUS GASTRITIS

Idiopathic granulomatous gastritis (IGG) is a diagnosis made only by e xcluding other causes of granulomatous gastritis, such as infection, f oreign bodies, and systemic granulomatous diseases. Recently, several investigators have questioned the existence of IGG. We reviewed the sl ides and clinical data of all cases of granulomatous gastritis seen at the Cleveland Clinic between 1975 and 1994. In addition to routine he matoxylin and eosin stains, slides from all cases were stained with Zi ehl-Neelson, Gomori's methenamine silver, and Giemsa stains. Clinical information and follow-up were available for 42 patients. The clinicop athologic diagnoses of the 42 patients with granulomatous gastritis we re as follows: Crohn's disease(n = 23), three of whom had concomitant chronic active gastritis with Helicobacter pylori infection; sarcoidos is (n = 9), four of whom had concomitant chronic active gastritis with H. pylori infection; chronic active gastritis with H. pylori infectio n and no other systemic illness (n = 2); distal esophageal adenocarcin oma and chronic active gastritis (n = 2); mucosa-associated lymphoid t issue (MALT) lymphoma with chronic active gastritis and presumed H. py lori infection (n = 2): peptic ulcer complications (n = 2); hypertroph ic lymphocytic gastropathy with chronic active gastritis (n = 1); and possible Crohn's disease (n = 1). We conclude that (a) in most cases o f granulomatous gastritis, a diagnosis of Crohn's disease or sarcoidos is could be established; (b) the background inflammatory pattern was h elpful in suggesting a diagnostic category for granulomatous gastritis ; (c) granulomatous gastritis is not associated with H. pylori per se; however, if known cases of Crohn's disease and sarcoidosis are exclud ed, an association between H. pylori and granulomatous gastritis canno t be ruled out; and (d) IGG, if it exists, is extremely rare.