2- Stomach

Chronic Gastritis

  • Etiology:

    • The primary cause of chronic gastritis is infection with Helicobacter pylori.

    • Another significant cause is autoimmune gastritis.

    • Less prevalent causes include radiation injury and chronic bile reflux.

  • Symptoms:

    • Symptoms associated with chronic gastritis tend to be less severe than acute gastritis but are more persistent.

Morphology

  • Organism Localization:

    • The H. pylori organism is primarily found in the superficial mucus that covers the epithelial cells in the gastric mucosa.

  • Inflammatory Reaction:

    • There is typically a notable inflammatory response, both acute and chronic, that includes lymphoid aggregates, some of which exhibit germinal centers.

  • Intestinal Metaplasia:

    • Over time, intestinal metaplasia can develop, evidenced by the presence of goblet cells, which is linked to an increased risk of gastric adenocarcinoma.

Pathogenesis of Peptic Ulcer Disease (PUD)

  • Gastric Hyperacidity:

    • Hyperacidity is crucial to the development of PUD, which may stem from:

      • H. pylori infection

      • Parietal cell hyperplasia

      • Tumors such as Zollinger-Ellison syndrome, characterized by excessive gastrin release leading to heightened acid production.

  • Disruption of Mucosal Protection:

    • Factors disrupting mucosal defenses include:

      • Chronic NSAID use

      • Cigarette smoking

      • High-dose corticosteroids, which inhibit prostaglandin synthesis.

    • Conditions such as hypercalcemia can also induce PUD by stimulating gastrin production, thus increasing acid secretion.

Chronic Gastric Ulcer (Microscopic Features)

  • Cellular Features:

    • Fibrin Presence: Indicates ongoing inflammation.

    • Inflammation: Persistent inflammation characterizes chronic ulcers.

    • Granulation Tissue: Forms as part of the healing process.

    • Fibrosis: May develop over time, resulting in complications.

Complications of Chronic Gastric Ulcer

  1. Hemorrhage:

  • Can lead to hematemesis (vomiting blood) and melena (black stool).

  • Chronic blood loss may result in anemia.

  1. Perforation:

  • Can cause the passage of food, gastric juice, and bacteria into the peritoneal cavity, leading to peritonitis.

  1. Fibrosis:

  • May result in pyloric obstruction due to scar tissue formation.

  1. Malignant Changes:

  • Rare, occurring in less than 1% of cases.