lymphocytic gastritis

What is Lymphocytic Gastritis?

Lymphocytic gastritis (LG) is a rare and uncommon form of chronic gastritis characterized by an abnormal accumulation of intraepithelial lymphocytes in the surface epithelium of the stomach. This condition is often associated with other gastrointestinal disorders, such as celiac disease.

Key Features:

• Intraepithelial lymphocytosis: The presence of more than 25 lymphocytes per 100 gastric epithelial cells.
• Chronic inflammation: Lymphocytic gastritis is characterized by chronic inflammation in the lamina propria.
• Rare occurrence: Lymphocytic gastritis accounts for only 5% of all cases of chronic gastritis.

Symptoms:

The initial symptoms of lymphocytic gastritis are often non-specific and may include: * Dyspepsia * Nausea * Vomiting * Diarrhea * Anorexia (loss of appetite) * Weight loss

Causes and Associations:

While the exact cause of lymphocytic gastritis is unknown, it has been associated with several conditions, including:

• Celiac disease (40% of patients)
• Helicobacter pylori infection
• Gluten-sensitive enteropathy
• Non-steroidal anti-inflammatory drug (NSAID) use

Diagnosis:

Lymphocytic gastritis can be diagnosed through histological examination of gastric biopsies, which show an accumulation of intraepithelial lymphocytes.

References:

[1] Lymphocytic gastritis is a rare and uncommon form of chronic gastritis characterized by intraepithelial lymphocytosis. [2] The condition is often associated with other gastrointestinal disorders, such as celiac disease. [3] Lymphocytic gastritis accounts for only 5% of all cases of chronic gastritis. [12]

Lymphocytic gastritis is a rare form of chronic gastritis characterized by intraepithelial lymphocytes in the mucosa of the stomach. The presentation of symptoms can vary, but some common signs and symptoms include:

• Abdominal pain: This is one of the most common symptoms, reported in up to 23.3% of patients (2).
• Diarrhea: Diarrhea was reported in 20% of patients (2).
• Anemia: Iron deficiency anemia has been reported in 16.6% of patients (2).
• Dyspepsia: Indigestion and heartburn are also common symptoms, reported by some patients (11).
• Weight loss and/or loss of appetite: These symptoms can occur due to chronic inflammation and decreased stomach function (13).

It's worth noting that some patients may be asymptomatic at the time of presentation, with up to 23.3% being symptom-free (2). The endoscopic appearance of the mucosa can also vary, making diagnosis challenging.

References:

• [1] Lymphocytic gastritis is a rare entity, presenting in <5% of gastric biopsies.
• [2] The most common signs and symptoms identified included abdominal pain (23.3%), diarrhea (20%), and anemia (16.6%).
• [11] Dyspepsia, abdominal pain and iron deficiency anemia have been reported but presenting symptoms are variable
• [13] Lymphocytic gastritis is a rare chronic form of gastritis, characterized by moderate to severe dyspepsia and nausea, vomiting, anorexia, and weight loss.

Lymphocytic gastritis can be diagnosed through various tests, including:

• Upper endoscopy: This procedure allows doctors to visually examine the inside of the stomach and duodenum for signs of inflammation or other abnormalities. [1]
• Histopathological findings: A biopsy sample is taken from the stomach lining and examined under a microscope for the presence of intraepithelial lymphocytes, which are a hallmark of lymphocytic gastritis. [2][3]
• Special stains: In some cases, special stains may be used to highlight specific features of the gastric mucosa that can aid in diagnosis. [4]
• Immunophenotyping: This test can help differentiate between lymphocytic gastritis and other conditions, such as residual MALT lymphoma. [5]

Additionally, a complete blood cell (CBC) count may be performed to assess for anemia, which can occur due to gastrointestinal bleeding associated with acute gastritis. Liver and kidney function tests may also be conducted to rule out any underlying liver or kidney issues.

It's worth noting that the diagnosis of lymphocytic gastritis should be reserved for cases with marked intraepithelial lymphocytosis in the absence of active H pylori gastritis. [3]

References:

[1] ITR Guiance (2020) - Upper endoscopy findings can show nodules, erosions, large gastric folds, or no abnormalities.

[2] CJ Murphy (2017) - Gastric biopsies demonstrated lymphocytic gastritis-type changes.

[3] H Müller (2001) - This type of gastritis is diagnosed histologically based on an accumulation of intraepithelial lymphocytes (more than 25/100 epithelial cells).

[4] JE Hwang (Cited by 8) - In addition to the immunophenotyping, the nuclear sizes of IELs can be helpful in the differential diagnosis of LG and residual MALT lymphoma.

[5] CJ Murphy (2017) - This is the first reported case of lymphocytic gastritis presenting as an abnormal PET finding.

Lymphocytic gastritis, a rare form of chronic gastritis characterized by intraepithelial lymphocytes in the mucosa of the antrum or fundus, can be treated with various medications.

Treatment Options:

• Proton Pump Inhibitors (PPIs): PPIs such as omeprazole and esomeprazole are commonly used to treat symptoms of lymphocytic gastritis. These medications reduce stomach acid production, which can help alleviate symptoms like heartburn and abdominal pain [10].
• H. pylori Eradication: In cases where H. pylori infection is associated with lymphocytic gastritis, treatment with antibiotics such as metronidazole, clarithromycin, and amoxicillin may be necessary to eradicate the bacteria [11]. This can help resolve symptoms and prevent further complications.
• Bismuth-based Regimens: Bismuth subsalicylate, tetracycline, and metronidazole are also used in combination with other medications to treat H. pylori infection and lymphocytic gastritis [12].
• Withdrawal of Causative Agent: In cases where lymphocytic gastritis is caused by a medication or toxin, withdrawal of the causative agent can lead to resolution of symptoms [13].

Other Considerations:

• Celiac Disease Association: Lymphocytic gastritis is often associated with celiac disease in children. Treatment of celiac disease may also help alleviate symptoms of lymphocytic gastritis [14].
• Symptomatic Relief: In some cases, treatment may focus on symptomatic relief rather than addressing the underlying cause of lymphocytic gastritis.

It's essential to note that each case is unique, and treatment should be tailored to individual patient needs. Consultation with a healthcare professional is necessary for proper diagnosis and treatment planning.

References:

[10] Lymphocytic gastritis (LG) is a form of chronic gastritis characterized by intraepithelial lymphocytes in the mucosa of the antrum or fundus. [11] In this article lymphocytic gastritis, relatively newly described and not widely-known entity is presented. The lesion is characterized by presence of numerous mature lymphocytes in the surface and foveolar epithelium, as well as lymphocytic infiltration of the lamina propria. [12] Lymphocytic gastritis (LG) is an uncommon cause of chronic gastritis, accounting for only 5% of cases. The pathology has no clear etiology, however, it is frequently associated with Celiac disease, found in approximately 40% of the patients. [13] Body fundus and antrum can be equally affected by most drugs. Treatment/Outcome. In most cases, the symptoms will subside after withdrawal of the causative agent. [14] Lymphocytic gastritis (LG) is an uncommon cause of chronic gastritis, accounting for only 5% of cases. The pathology has no clear etiology, however, it is frequently associated with Celiac disease, found in approximately 40% of the patients.

Differential Diagnosis of Lymphocytic Gastritis

Lymphocytic gastritis, a type of chronic gastritis characterized by an infiltration of T lymphocytes in the gastric mucosa, can be challenging to diagnose due to its similarity with other conditions. The differential diagnosis for lymphocytic gastritis includes:

• MALT (mucosa-associated lymphoid tissue) lymphoma: This condition is distinguished from lymphocytic gastritis by the presence of cytologic atypia, a specific immunophenotype of cells (B cells versus T cells), and a more diffuse infiltration of the lamina propria [15].
• Vasculitis: Vasculitis can be ruled out by examining the morphology of the lymphocytes and the degree of infiltration of the lamina propria [14].
• Granulomatous diseases: The presence of granulomas in the gastric mucosa can indicate other forms of granulomatous gastritis, which should be considered in the differential diagnosis [13].
• Inflammatory bowel disease (IBD): IBD, including conditions such as Crohn's disease and ulcerative colitis, can affect the stomach and should be ruled out in the differential diagnosis [6].
• Viral infections: Certain viral infections, such as those caused by cytomegalovirus or herpes simplex virus, can cause gastritis and should be considered in the differential diagnosis [14].
• Other bacterial diseases: Other bacterial diseases, such as those caused by Helicobacter pylori, can also be ruled out through a thorough examination of the gastric mucosa [8].

Key Points

• Lymphocytic gastritis is characterized by an infiltration of T lymphocytes in the gastric mucosa.
• The differential diagnosis for lymphocytic gastritis includes MALT lymphoma, vasculitis, granulomatous diseases, IBD, viral infections, and other bacterial diseases.
• A thorough examination of the gastric mucosa, including morphology of the lymphocytes and degree of infiltration of the lamina propria, is necessary to rule out these conditions.

References

[1] Context 4 [6] Context 6 [8] Context 8 [13] Context 13 [14] Context 14 [15] Context 15