Gastritis: The clinico-pathological spectrum

Dig Liver Dis. 2021 Oct;53(10):1237-1246. doi: 10.1016/j.dld.2021.03.007. Epub 2021 Mar 28.


The inflammatory spectrum of gastric diseases includes different clinico-pathological entities, the etiology of which was recently established in the international Kyoto classification. A diagnosis of gastritis combines the information resulting form the gross examination (endoscopy) and histology (microscopy). It is important to consider the anatomical/functional heterogeneity of the gastric mucosa when obtaining representative mucosal biopsy samples. Gastritis includes self-limiting and non-self-limiting (long-standing) inflammatory diseases, and the latter are epidemiologically, biologically and clinically linked to the onset of gastric cancer (i.e. "inflammation-associated cancer"). Different biological models of inflammation-associated gastric oncogenesis have been proposed. Helicobacter pylori (H. pylori) gastritis is the most prevalent worldwide, and H. pylori is classified as a first-class carcinogen. On these bases, eradicating H. pylori is mandatory for the primary prevention of gastric cancer. Non-self-limiting gastritis may also be triggered by the immune-mediated destruction of gastric parietal cells, resulting in autoimmune gastritis. In both H. pylori-related and autoimmune gastritis, the non-self-limiting inflammation results in atrophy of the gastric mucosa, which is the main factor promoting gastric cancer. Long-term follow-up studies consistently demonstrate the prognostic impact of the histological staging of gastritis in gastric cancer secondary prevention strategies.

Keywords: Atrophic border; Atrophic gastritis; Autoimmune gastritis; Gastric biopsy protocol; Gastric cancer; Gastric metaplasia; Intestinal Metaplasia; OLGA staging; SPEM.

Publication types

  • Review

MeSH terms

  • Biopsy
  • Endoscopy
  • Gastric Mucosa / pathology*
  • Gastritis, Atrophic / microbiology
  • Gastritis, Atrophic / pathology*
  • Helicobacter Infections / complications
  • Helicobacter Infections / pathology
  • Humans
  • Precancerous Conditions
  • Stomach / pathology
  • Stomach Neoplasms / etiology
  • Stomach Neoplasms / prevention & control