THE MORPHOLOGY OF GASTRITIS

Gastritis is a histopathologic diagnosis, which correlates poorly with both clinical symptoms of non-ulcer dyspepsia and endoscopic abnormal ities. Worldwide, most cases of gastritis are due to Helicobacter pylo ri and are characterized by a diffuse superficial antral gastritis. Ch ronic inflammatory cells and lymphoid follicles are present in the lam ina propria, Neutrophils are present in the surface and pit-lining epi thelium. In North America and Western Europe, reactive gastropathy due to duodenal reflux or non-steroidal anti-inflammatory agents is also common. In this condition, there is no increase in inflammatory cells, but the pit-lining cells become hyperplastic, and the pits have a cor kscrew appearance. Most examples of multifocal atrophic gastritis are the result of long standing Helicobacter gastritis, although there may be other causes as well. It is characterized by loss of glands in bot h pyloric and corpus mucosae with intestinal metaplasia of the surface epithelium. A subtype of intestinal metaplasia, in which sulphomucin (large bowel mucin) is present, has been associated with the developme nt of distal gastric cancer. However, this association is relatively w eak and is not considered useful for screening purposes. Gastric dyspl asia may develop in areas of the stomach affected by intestinal metapl asia. High-grade dysplasia is a significant finding, with up to 60 per cent of cases having coincident carcinoma and a further 25 percent of cases likely to develop an invasive malignancy within fifteen months.