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Lymphocytic Gastritis

Once you have mastered H pylori gastritis and the atrophic gastritides , there are only a few more gastritides about which we know anything. Lymphocytic Gastritis. At low power, there is inflammation, mainly superficial. Check out the mess in the surface epithelium!.

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Lymphocytic Gastritis

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  1. Once you have mastered H pylori gastritis and the atrophic gastritides, there are only a few more gastritides about which we know anything

  2. Lymphocytic Gastritis

  3. At low power, there is inflammation, mainly superficial. Check out the mess in the surface epithelium!

  4. Surface epithelial lymphocytosis with epithelial injury

  5. Same surface as in sprue

  6. Plasmacytosis in LP

  7. H pylori associated lymphocytic gastritis

  8. H pylori immunostain in an adjacent field

  9. Lymphocytic gastritis can produce polyps

  10. Some cases of lymphocytic gastritis have the giant folds and protein losing of Menetrier’s disease

  11. Small patches of lymphocytic gastritis like this pop up next to all kinds of things

  12. Lymphocytic gastritis next to a carcinoma

  13. Lymphocytic Gastritis • Clinical Aspects • Endoscopic: • nothing, polyps, giant folds • Clinical: • nothing, sprue-associated, • Menetrier’s syndrome, • H pylori elsewhere

  14. FOCAL …ITIS • Very, very common • More common after search • More common if there are residents • The entire gut is at risk • Almost never diagnostic • Annoying • The more foci the better!

  15. 2 tiny foci of gastric inflammation

  16. Multiple tiny foci

  17. One big focus

  18. Often mainly lymphocytes with PMNs, macrophages and epithelial damage

  19. Was found often in patients with Crohn’s Then it was found in patients with UC

  20. Given the name “focally enhanced gastritis”

  21. Every so often a granuloma or 2 may be part of focal gastritis

  22. Chemical (Reactive) Gastropathy

  23. At low power, the dominant change is the prominence of the PITS

  24. The high N:C resembles dysplasia PITS, PITS and more PITS, often serrated contours

  25. This change is an expansion of the proliferative zone (actually, the neck region, not the pits)in compensation for surface epithelial injury. This is very common in our practice. Most of the time, we do not know the cause.

  26. Stomach Small bowel Originally described on the gastric side of a gastro-enteric anastomosis, due to bile reflux

  27. Superimposed erosion (necrotic superficial mucosa

  28. In almost 20 year old studies of patients with chronic NSAIDs use. Not much change recently. Gastric erosions occur in 40-60% Gastric ulcers occur in 10-30% Duodenal ulcers occur in 5%

  29. Acute erosion—resembles acute ischemic injury

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