Attilio Giacosa

Chronic gastritis : its clinical and physiopathological meaning

Chronic gastritis (CG) is the chronic inflammation of gastric mucosa associated with varying degrees of damage of superficial and glandular epithelia. The causes of CG are exogenous (mainly Helicobacter pylori) and endogenous. The process is concluded by atrophy of parenchyma. CG is associated with dyspepsia in approximately 50% of cases, but frequently with gastric and duodenal ulcer. The role of chronic atrophic gastritis (AG) is relevant in development of cancer or of other tumors like carcinoids and polyps. The specific secretive cells of the glandular parenchyma and of the superficial epithelium reveal a good correlation with secretory component behavior, but they are only partially influenced by H. pylori. It emerges that CG is an anatomic-functional condition. The cytofunctional profile in AG causes achlorhydria and therefore chronic luminal alkalosis. This condition favors intestinal metaplasia (IM) and important intraluminal troubles. Finally, nutritional deficiencies or H. pylori seem to interfere with the intragastric metabolism and therefore play a relevant role in the rise of IM.

Chronic Atrophic Gastritis and Cancer

Although chronic gastritis is basically an anatomofunctional condition, it has clinical importance for its possible neoplastic implications.

Normal Stomach: Morphology

In the present critical analysis of the subject, it is advisable to question whether the descriptive material available in the official anatomical literature constitutes the basis for acceptance. This consideration arises when we query whether a biological-clinical subject such as gastritis can be analyzed according to autoptic parameters. In fact the problem of gastritis affects man in vivo, reconsidered today in terms of an anatomy revisited according to endoscopic and histobioptic parameters.

Menetrier’s Disease

In 1888, Menetrier described the diffuse thickening of the gastric wall which is secondary to hypertrophy of the mucosa. This condition, which has been described in varions ways (giant hypertrophic gastritis, exudative hypertrophic gastropathy, giant rugal hypertrophy, gastric adenopapillomatosis, proliferative hypertrophic gastritis), is presently less frequently found than previously thought. This is probably due to the fact that data obtained in the preendoscopic era were then supplemented with those derived from radiological investigation, which were much too often inclined to assess the presence of “giant rugal hypertrophic gastropathies.”

Chronic Gastritis and Duodenal Ulcer

The well-known hypersecretory gastric profile of duodenal ulcer has long encouraged morphological investigations of the fundic gastric mucosa, in that the peptic role of acid secretion, closely linked to the parietal cell mass, is now widely accepted. The more recent morphological investigation has enabled us to widen our knowledge to the antral mucosa as well, thus establishing the frequency of the inflammation.

Chronic Gastritis and Polyps

The term polyp refers to the morphological aspect of epithelial or mesenchymal lesions of spherical shape, sessile or peduncolated, extending into the lumen.

Gastritis of the Operated Stomach

The large number of patients operated upon because of a benign gastric or duodenal pathology has long stimulated interest in the problem of inflammatory alterations of the operated stomach.

Chronic Gastritis and Gastric Ulcer

The interest in the relationships between gastric ulcer and chronic gastritis arises in relation to observations which have long shown chronic gastritis to be frequently associated with gastric ulcer.

Chronic Gastritis and Endocrine Tumors

Recent advances in the study of endocrine gastric cells have opened the problem of possible neoplastic endocrine conditions in relation to chronic gastritis.

Definition of Gastritis

Gastritis is the inflammation of the gastric mucosa; this definition is based on precise anatomical criteria. The introduction first of gastroscopy, then of tube biopsy, and finally of fibroscopy with simultaneous biopsy and cytology enable definitive diagnosis of gastritis; these techniques provide morphological accuracy and thus a reference point for statements about the physiopathological and clinical condition. Gastritis can be acute or chronic; it is a clinical entity that can manifest itself in different ways, quite apart from etiological considerations. Acute gastritis is an inflammatory process caused by exogenous or endogenous factors. It involves the mucosa and, at times, the whole gastric wall, and manifests itself clinically with acute characteristics.