Lymphocytic Gastritis: A Distinct Nosologic Entity or a Histopathologic Expression of Other Conditions?
Maryam Kherad Pezhouh, Amber Cockburn, Robert Genta. Miraca Life Sciences Research Institute, Irving, TX; University of Texas Southwestern Medical Center, Dallas, TX
Background: Lymphocytic gastritis (LG) has been associated with a form of severely erosive nodular gastritis (varioliform gastritis). However, increased lymphocytic infiltrates in the gastric epithelium are reported in patients with H. pylori infection, celiac disease and microscopic colitis. This study was designed to determine whether LG is a distinct nosologic entity irrespective of its associations, or represents the histopathologic manifestation of other conditions.
Design: Using a nationwide pathology database, we extracted all patients who had an esophagogastroduodenoscopy (EGD) with a histopathologic diagnosis of LG and duodenal and colonic biopsies between 1/2008 - 12/2011. Patients with gastrointestinal cancer or surgery were excluded. LG patients were divided in two groups: LG without concurrent intestinal lymphocytosis (LG-Alone); and LG with intestinal lymphocytosis (duodenal, celiac sprue, or microscopic colitis; LG-IL). Patients with LG with H. pylori infection were also analyzed separately.
Results: There were 206 patients with LG and simultaneous duodenal and colonic biopsies: 91 patients (median age 61 years; 54% female) had LG-Alone (21 with H. pylori infection) and 115 (median age 65 years; 71% female) had LG-IL (5 with H. pylori infection). Compared to those with LG-IL, patients with LG-Alone were more likely to have erosions/ulcers (15.4% vs. 7.8%; OR 2.15) and twice as likely to be male (46% vs. 29%; OR 2.13). Anemia was a more common indication for EGD in patients with LG-Alone (22% vs. 14%), while diarrhea and vomiting were more common in patients with associated lymphocytosis than in those with LG-Alone. H. pylori infection was more common in patients with LG-Alone than in those with LG-IL (23% vs. 4.4%; OR 6.54); however, when patients with H. pylori were excluded, the correlations remained similar.
Conclusions: These data suggest that gastric intraepithelial lymphocytosis may not be a single disease. In some patients it is the epiphenomenon of intestinal conditions characterized by intraepithelial lymphocytosis and a high prevalence of diarrhea. In other, younger and mostly male patients, it is restricted to the stomach, is associated with a higher prevalence of anemia and may be the expression of an autoimmune phenomenon. In a portion of LG-Alone patients intraepithelial lymphocytosis may be associated with or precipitated by H. pylori infection. The relative rarity of ulcers and erosions suggests that varioliform gastritis may have become an obsolete condition.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 101, Monday Morning