The pattern of involvement of the gastric mucosa in lymphocytic gastritis is predictive of the presence of duodenal pathology

Aim-To determine whether the pattern of involvement of the gastric mucosa i n lymphocytic gastritis is predictive of the presence or absence of duodena l pathology. Methods-50 cases (M:F, 26:24; median age 57 years) diagnosed as lymphocytic gastritis between 1986 and 1998 with concurrent duodenal (D2) biopsies wer e identified from a computer search of the pathology records and validated by counting gastric intraepithelial lymphocytes. Gastric and duodenal intra epithelial lymphocyte counts were performed on haematoxylin and eosin (H&E) and anti-CD3 stained sections. D2 biopsies were assessed for villous atrop hy and chronic inflammatory cell infiltration by subjective grading, and ga stritis was classified and graded according to the updated Sydney system. A case was designated corpus predominant when the corpus chronic inflammatio n grade exceeded that of the antrum. If it was less, then the case was antr um predominant, and if they were equal it was diffuse (pan-) gastritis, The ratio between the corpus and antral intraepithelial lymphocyte count in in dividual patients was calculated. Results-Of 50 cases of lymphocytic gastritis, 21 were classified as corpus predominant. With one exception (a case of mild villous atrophy), all were accompanied by normal duodenal morphology. Cases with a corpus predominant gastritis had median duodenal intraepithelial lymphocyte counts of 19 (H&E) and 14.1 (CD3), whereas 29 subjects with an antrum predominant or diffuse gastritis had median counts of 39.9 (H&E) and 37.9 (CD3). Fifteen of these 29 cases (52%) showed villous atrophy; all were graded as moderate or sever e. Patients with any degree of villous atrophy had a mean corpus/antrum int raepithelial lymphocyte ratio (H&E) of 0.59 (representing antral predominan ce), while those with normal duodenal morphology had a ratio of 2.39 (p < 0 .0001). Conclusions-The pattern of involvement of gastric mucosa in lymphocytic gas tritis is closely related to the associated duodenal pathology. Those with the corpus predominant form are unlikely to have duodenal pathology, while those with an antral predominant or diffuse form should have distal duodena l exclude villous atrophy.