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Гастроэнтерология (анг,рус)

Miscellaneous Forms of Gastritis

Lymphocytic gastritis is characterized histologically by intense infiltration of the surface epithelium with lymphocytes. The infiltrative process is primarily in the body of the stomach and consists of mature T cells and plasmacytes. The etiology of this form of chronic gastritis is unknown. It has been described in patients with celiac sprue. No specific symptoms suggest lymphocytic gastritis. A subgroup of patients have thickened folds noted on endoscopy. These folds are often capped by small nodules that contain a central depression or erosion; this form of the disease is called varioliform gastritis. H. pylori probably plays no significant role in lymphocytic gastritis. Therapy with glucocorticoids or sodium cromoglycate has obtained unclear results.

 

Marked eosinophilic infiltration involving any layer of the stomach (mucosa, muscularis propria, and serosa) is characteristic of eosinophilic gastritis. Affected individuals will often have circulating eosinophilia with clinical manifestation of systemic allergy. Involvement may range from isolated gastric disease to diffuse eosinophilic gastroenteritis. Antral involvement predominates, with prominent edematous folds being observed on endoscopy. These prominent antral folds can lead to outlet obstruction. Patients can present with epigastric discomfort, nausea, and vomiting. Treatment with glucocorticoids has been successful.

 

Several systemic disorders may be associated with granulomatous gastritis. Gastric involvement has been observed in Crohn's disease. Involvement may range from granulomatous infiltrates noted only on gastric biopsies to frank ulceration and stricture formation. Gastric Crohn's disease usually occurs in the presence of small-intestinal disease. Several rare infectious processes can lead to granulomatous gastritis, including histoplasmosis, candidiasis, syphilis, and tuberculosis. Other unusual causes of this form of gastritis include sarcoidosis, idiopathic granulomatous gastritis, and eosinophilic granulomas involving the stomach. Establishing the specific etiologic agent in this form of gastritis can be difficult, at times requiring repeat endoscopy with biopsy and cytology. Occasionally a surgically obtained full-thickness biopsy of the stomach may be required to exclude malignancy.

 

Menetrie`s disease

In this rare condition the gastric pits are elongated and tortuous, with replacement of the parietal and chief cells by mucus-secreting cells. As a result, the mucosal folds of the body and fundus are greatly enlarged. Most patients are hypochlorhydric. Whilst some patients have upper gastro-intestinal symptoms, the majority present in middle or old age with protein-losing enteropathy due to exudation from the gastric mucosa. Barium meal shows enlarged, nodular and coarse folds which are also seen at endoscopy, although biopsies may not be deep enough to show all the histological features. Treatment with anti-secretory drugs may reduce protein loss but unresponsive patients require partial gastrectomy. 

 

 

 

 

 

 

 

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