Chronic gastritis

Chronic gastritis is common in adults and may be associated with a number of conditions including gastric ulcers and Helicobacter pylori (HP). It usually involves the gastric body and antrum of the stomach. Most patients are asymptomatic and do not require any treatment. At present there is no indication for widespread use of HP eradication therapy in patients with chronic gastritis but without evidence of peptic ulcer disease. Chronic gastritis can be classified as:

• Type B (bacterial infection)

Type A: autoimmune chronic gastritis (ACG)

ACG involves the body of the stomach but does not affect the antral region and results from autoimmune activity against parietal cells. The histological features are diffuse chronic inflammation, atrophy and loss of fundi glands, intestinal metaplasia and sometimes hyperplasia of enterochromaffin-like (ECL) cells. In some patients the degree of gastric atrophy is severe and loss of intrinsic factor secretion leads to pernicious anaemia. The gastritis itself is usually asymptomatic but some patients have evidence of other organ-specific autoimmunity, particularly thyroid disease. There is a fourfold increase in the risk of gastric cancer development.

Type B: bacterial infection

HP infection is present in about 90% of Type B gastritis cases. It provokes an acute inflammatory response. Type B gastritis can affect the entire stomach.

Type C: reflux gastritis

Reflux gastritis is caused by the regurgitation of duodenal contents into the stomach through the pylorus. It may be present with dyspepsia and bilious vomiting.

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