Recent advances in the histopathology of gastritis

Helicobacter pylori is now accepted as the cause of gastritis and the gastritis-associated diseases (duodenal ulcer, gastric ulcer, and gastric carcinoma). Duodenal ulcer is typically associated with antral-predominant gastritis and little/no atrophy. Gastric ulcer and the intestinal type of gastric cancer are typically associated with extensive gastritis and widespread intestinal metaplasia. The gastritis pattern is determined by a person's acid secretory status, which is the major determinant of disease outcome(s). The natural history of H. pylori gastritis is for the inflammation to progress from the antrum into the adjacent corpus, resulting in an atrophic front of advancing injury, leading to a reduction in acid secretion, loss of parietal cells, and development of atrophy. The pattern, extent, and severity of atrophy with or without intestinal metaplasia are a far more important predictor of atrophy than the intestinal metaplasia subtype. The challenge remains to identify a reliable marker for malignancy potential.