Authors

  • Sherbek Jabborov

DOI:

https://doi.org/10.71337/inlibrary.uz.science-research.73322

Keywords:

Inflammation gastropathy mucosal disorder epithelial injury subsequent regeneration inflammatory reaction.

Abstract

Gastritis refers to the inflammation of the gastric mucosa and is often used to describe the abnormal appearance of abnormal gastric mucosa on endoscopy or radiology. Gastritis encompasses infectious or immunological inflammation of the gastric mucosa and the host's response. Histopathological evidence of inflammation in the stomach lining is essential to diagnose this condition. Gastropathy is characterized as a gastric mucosal disorder without inflammation, often featuring epithelial injury and subsequent regeneration. Gastritis and gastropathy are not mutually exclusive conditions and might sometimes coexist. In clinical practice, gastritis may be accompanied by signs of mucosal injury, whereas gastropathy may show some evidence of an inflammatory reaction in the gastric mucosa. Gastritis can be classified based on the acuity of the condition (acute versus chronic), the histological features of the inflammation, or its etiology. Although there is no universally accepted categorization and classification of gastritis, it is crucial to understand the histological characteristics and etiological factors associated with the different types of gastritis to comprehend their presentation and classification. Appropriate histological evaluation is also essential in devising management plans for this disease. This review discusses the histological and morphological presentations of gastritis, assesses their prognostic significance, and outlines the guideline-recommended management approaches for these conditions. The primary objective of this topic is to improve patient outcomes by enhancing the competence of healthcare providers.

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GASTRITS: ETIOLOGY AND TREATMENT

Jabborov Sherbek Otabek o’g’li

Asian International University, Bukhara, Uzbekistan.

https://doi.org/10.5281/zenodo.15070415

Abstract.

Gastritis refers to the inflammation of the gastric mucosa and is often used to

describe the abnormal appearance of abnormal gastric mucosa on endoscopy or

radiology. Gastritis encompasses infectious or immunological inflammation of the gastric

mucosa and the host's response. Histopathological evidence of inflammation in the stomach

lining is essential to diagnose this condition. Gastropathy is characterized as a gastric mucosal

disorder without

inflammation,

often

featuring

epithelial

injury

and

subsequent

regeneration. Gastritis and gastropathy are not mutually exclusive conditions and might

sometimes coexist. In clinical practice, gastritis may be accompanied by signs of mucosal injury,

whereas gastropathy may show some evidence of an inflammatory reaction in the gastric

mucosa. Gastritis can be classified based on the acuity of the condition (acute versus chronic),

the histological features of the inflammation, or its etiology. Although there is no universally

accepted categorization and classification of gastritis, it is crucial to understand the histological

characteristics and etiological factors associated with the different types of gastritis to

comprehend their presentation and classification. Appropriate histological evaluation is also

essential in devising management plans for this disease. This review discusses the histological

and morphological presentations of gastritis, assesses their prognostic significance, and outlines

the guideline-recommended management approaches for these conditions. The primary objective

of this topic is to improve patient outcomes by enhancing the competence of healthcare

providers.

Keywords:

Inflammation, gastropathy, mucosal disorder, epithelial injury, subsequent

regeneration, inflammatory reaction.

ГАСТРИТЫ: ЭТИОЛОГИЯ И ЛЕЧЕНИЕ

Аннотация.

Гастрит относится к воспалению слизистой оболочки желудка и

часто используется для описания аномального вида аномальной слизистой оболочки

желудка при эндоскопии или рентгенологии. Гастрит охватывает инфекционное или

иммунологическое воспаление слизистой оболочки желудка и реакцию хозяина.

Гистопатологические доказательства воспаления в слизистой оболочке желудка

необходимы для диагностики этого состояния. Гастропатия характеризуется как

расстройство слизистой оболочки желудка без воспаления, часто с повреждением

эпителия и последующей регенерацией. Гастрит и гастропатия не являются

взаимоисключающими состояниями и иногда могут сосуществовать. В клинической


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практике гастрит может сопровождаться признаками повреждения слизистой

оболочки, тогда как гастропатия может показывать некоторые признаки

воспалительной реакции в слизистой оболочке желудка. Гастрит можно

классифицировать на основе остроты состояния (острый или хронический),

гистологических особенностей воспаления или его этиологии. Хотя не существует

общепринятой категоризации и классификации гастрита, крайне важно понимать

гистологические характеристики и этиологические факторы, связанные с различными

типами гастрита, чтобы понять их проявления и классификацию. Соответствующая

гистологическая оценка также имеет важное значение при разработке планов лечения

этого заболевания. В этом обзоре обсуждаются гистологические и морфологические

проявления гастрита, оценивается их прогностическое значение и излагаются

рекомендуемые в руководствах подходы к лечению этих состояний. Основной целью этой

темы является улучшение результатов лечения пациентов путем повышения

компетентности поставщиков медицинских услуг.

Ключевые слова:

воспаление, гастропатия, нарушение слизистой оболочки,

повреждение эпителия, последующая регенерация, воспалительная реакция.

Introduction

Gastritis is the inflammation of the gastric mucosa and is often used to describe the

abnormal appearance of abnormal gastric mucosa on endoscopy or radiology. Gastritis

encompasses infectious or immunological inflammation of the gastric mucosa and the host

response. Histopathological evidence of inflammation in the stomach lining is essential to

diagnose this condition. Gastropathy is a gastric mucosal disorder without inflammation,

featuring epithelial injury and subsequent regeneration. Gastritis and gastropathy are not

mutually exclusive conditions and might sometimes coexist. In clinical practice, gastritis may be

accompanied by signs of mucosal injury, whereas gastropathy may present with an inflammatory

reaction in the gastric mucosa.

Gastritis is classified based on the acuity of the condition (acute versus chronic), the

histological features of inflammation, or the etiology. Although the categorization and

classification of gastritis are not universally accepted, understanding the histological

characteristics and etiological factors associated with the different types of gastritis is essential.

Appropriate histological evaluation is also essential in devising management plans for

this disease. The primary objective is to equip treating clinicians with the ability to improve

patient outcomes through early intervention.


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Etiology

Acute Gastritis

Acute gastritis is temporary stomach lining inflammation caused by stress on the gastric

mucosa, manifesting as either hemorrhagic or non-hemorrhagic symptoms. This condition can

develop due to various factors, including uremia, ischemia, shock, corrosive agents, medications,

radiation, trauma, severe burns, sepsis, or alkaline-bile reflux. Certain infections, such as

enteroviruses, can also cause a self-limited episode of gastritis. Acute gastritis may result from

reduced gastric mucus secretion, mucosal barrier disruption, or decreased mucosal blood flow,

depending on the underlying cause.

Chronic Gastritis

Chronic gastritis is categorized into 2 forms—atrophic and non-atrophic. The primary

cause of chronic gastritis is a

Helicobacter pylori

infection, which typically starts with a non-

atrophic morphology. The non-atrophic form of chronic gastritis can progress to atrophic without

treatment. The most common cause of atrophic chronic gastritis is autoimmune gastritis, though

the etiology remains unclear. Autoimmune gastritis exhibits a chronic mononuclear inflammation

accompanied by severe atrophic gastritis, which usually affects the corpus, along with the

presence of autoantibodies against parietal cells or the intrinsic factor. However, whether

autoimmune gastritis is an independent disorder or if an

H pylori

infection triggers the

autoimmune response in susceptible individuals is unclear.

Reactive Gastritis

Reactive gastritis or gastropathy has numerous causative factors with acute gastritis.

Reactive gastritis may be caused by specific medications, alcohol consumption, radiation

exposure, and duodenal (bile) reflux. These causative agents lead to histological mucosal lesions

characterized by low-grade inflammation of the gastric mucosa. Although usually asymptomatic,

they are revealed through endoscopy, often showing multiple erosions or ulcers without signs of

atrophic changes. The use of immune checkpoint inhibitors to treat various malignancies has

contributed to the incidence of reactive gastritis, although the condition remains considerably

rare.

The Sydney System of Classification for Gastritis

The Histological Division of the Sydney System was introduced in 1990 and has since

become the most widely cited classification system for the morphological features of gastritis in

endoscopic biopsies. This system conveys information about the type, severity, and extent of

gastric pathology. The classification system conveys the topography of gastritis, which can be

restricted to the antrum or corpus or involve the entire stomach (pan gastritis).

If the etiology of the disease is known, this is added as a prefix to denote the topography.


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For instance, the label "autoimmune corpus gastritis" is used if the disease is

autoimmune. The Sydney System of Classification further delineates 5 graded morphological

variables that may be added as a suffix to the core topography. These variables include the type

or chronicity of inflammation, gastritis activity, intestinal metaplasia, the extent of atrophy, and

the presence or absence of

Heliobacter pylori

. The morphological features are graded as absent,

mild, moderate, or severe. The Sydney System of Classification recommends at least 2 random

biopsies from both the antrum and corpus, along with an additional biopsy from the incisura

angularis. Although the classification system provides a standardized and concise means of

documenting the extent and severity of gastritis, the method for predicting or forecasting future

morphological changes is impossible.

Classification of Gastritis Based on Etiological Factors

An alternative approach to classifying gastritis considers the etiology and chronicity of

the inflammation. This approach categorizes gastritis into 3 main subtypes—acute, chronic, and

special. Infectious gastritis is most commonly attributed to the global prevalence of

H

pylori

infection. Other types of infectious gastritis include phlegmonous gastritis (caused by

pyogenic bacteria), mycobacterial gastritis (caused by

Mycobacterium tuberculosis

), syphilitic

gastritis, viral gastritis (caused by cytomegalovirus and herpes simplex virus).

Granulomatous gastritis is a special gastritis observed in patients with Crohn disease and

sarcoidosis. Lymphocytic gastritis, collagenous gastritis, and eosinophilic gastritis are additional

special subtypes of gastritis with unclear etiologies. Lymphocytic and collagenous gastritis have

been associated with celiac disease, whereas eosinophilic gastritis has a strong connection to

atopic conditions and food allergens.

According to the 2015 Kyoto Consensus Conference, a classification of gastritis based on

etiological factors is outlined as follows:

Autoimmune gastritis

Infectious gastritis

o

Gastric phlegmon

o

Bacterial gastritis

H pylori

-induced

Enterococcal

Mycobacterial

o

Viral gastritis

Cytomegaloviral

Enteroviral

o

Fungal gastritis


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o

Parasitic gastritis

Gastric anisakiasis

Cryptosporidium

Gastric

Strongyloides stercoralis

Gastritis due to other diseases

o

Crohn disease

o

Sarcoidosis

o

Vasculitis

Gastritis due to external causes

o

Alcoholism

o

Radiation

o

Chemicals

Special gastritis

o

Allergic gastritis

o

Gastritis due to biliary reflux

o

Lymphocytic gastritis

o

Ménétrier disease

o

Eosinophilic gastritis

Epidemiology

Determining the incidence of acute gastritis can be challenging due to the common

causes, such as enterovirus infections, which typically result in mild and self-limited episodes

that go unreported. Other factors leading to acute gastritis, such as sepsis, ischemia, and caustic

injury, are relatively rare compared to chronic

H pylori–

associated gastritis and chronic atrophic

(autoimmune) gastritis. Recent data demonstrates chronic atrophic gastritis is estimated to affect

approximately 25% of the global population. Furthermore, the risk of developing chronic

atrophic gastritis is about 2.4 times higher in patients with

H pylori.

In Western populations, a declining incidence of infectious gastritis is thought to be

caused by an increasing prevalence of autoimmune gastritis. Autoimmune gastritis is more

prevalent in women and older individuals, with estimated rates ranging from 2,5% to 5,5%.

However, the available data may have limited reliability. Chronic

H pylori–

associated

nonatrophic gastritis continues to be highly prevalent in developing countries. In Western

populations, the prevalence of

H pylori

infection in children is approximately 15%, whereas the

prevalence is 54% in developing countries. The prevalence of

H pylori

infection in developing

countries varies significantly based on geographical region and socioeconomic conditions.


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Treatment / Management

Approach to Treatment

As mentioned earlier, eradicating

H pylori

is recommended for all patients with evidence

of gastritis on diagnostic testing. Furthermore, eradication therapy is the initial treatment option

for patients with dyspepsia who have a documented

H pylori

infection. In addition,

H

pylori

eradication therapy is indicated in patients with peptic ulcer disease, functional dyspepsia,

idiopathic thrombocytopenic purpura (ITP), unexplained iron-deficiency anemia, and in cases

where long-term nonsteroidal anti-inflammatory drug treatment is anticipated, particularly in

patients with a history of peptic ulcer disease. In patients with functional dyspepsia, eradication

therapy has a limited impact on symptom relief. Nonetheless, the therapy is advantageous in

mitigating the risk of peptic ulcer disease.

Eradication therapy for

H pylori

in patients with non-atrophic chronic gastritis is highly

recommended to promote healing and reduce the risk of gastric cancer. For patients with atrophic

gastritis, eradication therapy targeted at the organism may result in partial regression of the

gastritis and offer some potential benefits. Although the eradication therapy in patients with

intestinal metaplasia does not reverse the metaplastic changes, the progression to neoplasia is

slowed without reducing the overall risk of gastric cancer. Therefore, a cautious or weak

recommendation is considered in this context.

The management of chronic gastritis in patients who initially test negative for

H

pylori

lacks standardized guidelines and tends to exhibit significant variability. Empirical use of

proton-pump inhibitors (PPIs) has demonstrated effectiveness in alleviating symptoms for these

patients. According to current guidelines, empiric PPI therapy is recommended for individuals

aged younger than 60 with dyspepsia if they test negative for

H pylori

or experience persistent

symptoms despite undergoing eradication therapy. Patients who do not experience relief from

these treatments may be considered for prokinetic therapy or tricyclic antidepressants. Notably,

the supporting evidence is low-to-moderate quality.

Currently, definitive treatment does not exist for patients with atrophic gastritis. The

pivotal aspect in treating patients with atrophic gastritis is the application of risk stratification

systems to assess the severity of the disease and determine the risk of gastric malignancies. For

this purpose, utilizing the Operative Link on Gastritis Assessment (OLGA) and Operative Link

on Gastric Intestinal Metaplasia Assessment (OLGIM) grading systems is recommended. Staging

gastritis using the OLGA and OLGIM systems, with a stage III or IV classification, is associated

with a significantly elevated risk of gastric cancer. This approach provides an easily translated

method for assessing attributable risk.


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These systems incorporate atrophy scores obtained through histological assessment of

gastric biopsies and consider atrophy topography to assign clinical stages.

Histological Grading of Gastritis

In normal gastric mucosa, an acceptable range is typically 3 to 6 lymphocytes, plasma

cells, or macrophages per high power field, or 2 to 3 cells located between foveolae. The degree

of increase from these numbers determines the severity of gastritis, which is graded as mild (+--),

moderate (++-), or marked (+++). Notably, this density measurement should be performed away

from

any

lymphoid

follicles,

as

they

could

be

related

to

an

underlying

H

pylori

infection. Lymphocytic gastritis occurs when more than 25 lymphocytes are observed per

100 epithelial cells within the glandular epithelium. The density of neutrophils measures the

activity of gastritis. The grading of gastritis activity is followed as neutrophils in the lamina

propria indicate mild (+--) activity, neutrophils within the epithelium denote moderate (++-)

activity, and neutrophils in the glandular lumen signify marked (+++) activity.

The discrepancy between the expected glands for the anatomical site of the gastric

mucosa and what is observed represents atrophy. A reduction or complete absence of glandular

units leads to collagen deposition in the lamina propria. Metaplastic changes involve the

replacement of normal glandular units with metaplastic and/or dysplastic units. A score of 1 is

allocated when a 2% to 35% loss of the glandular architecture or its metaplastic transformation

occurs, a score of 2 is assigned for a 35% to 67% loss, and a score of 3 is designated for a loss

exceeding 65%. The OLGA staging system categorizes gastritis into 5 stages, each associated

with a progressively higher risk of cancer, determined by the atrophy score. In addition, an

overall atrophy score based on topography is assigned, and these scores are tallied to determine

the corresponding OLGA stage. Although the OLGIM staging system relies solely on intestinal

metaplasia for the atrophy score, enhancing inter-observer reproducibility, a notable decrease in

sensitivity for identifying high-risk patients is apparent.

Patients classified as OLGA/OLGIM stage III or IV face a considerable risk of

developing gastric adenocarcinoma. As a result, regular surveillance endoscopy is strongly

recommended for these individuals to enhance the chances of detecting gastric cancer in the

early stages, enabling surgical treatment. The AGA recommends endoscopic surveillance every 3

years in these patients. Other clinical factors that should be considered when determining the

frequency of surveillance include a family history of gastric cancer, residence in regions with a

high incidence of gastric cancer, a history of persistent

H pylori

infection, smoking history, and

dietary factors.


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Conclusion

According to the Kyoto Global Consensus Conference, etiology is taken for reference in

the classification of gastritis. The etiological picture of long-standing gastritis can include both

environmental (e.g.

H. pylori

) and host-related (e.g. Autoimmunity) agents, potentially resulting

in the atrophic transformation of native gastric mucosa. Epidemiological evidence implicates the

atrophic microenvironment in

H. pylori

gastritis as a major factor responsible for the

etiopathogenesis of more than 85% of gastric malignancies.

The atrophic transformation of gastric mucosa gives rise to different histological

phenotypes, all of which have been biologically profiled and can be histologically scored. They

may also be associated with a range of functional changes, which can serve as (quantitative)

serological markers of the atrophic process. It is easy to imagine the atrophy-remodeled gastric

microbiota having a role as co-promoter in the atrophic cancer-prone microenvironment.

Over the coming years, we will see how this multidisciplinary approach can be optimized

for the purpose of designing global strategies for eradicating gastric cancer and implementing

patient-tailored prevention strategies. The available evidence does suggest that combining

primary and secondary prevention strategies can realistically succeed in cutting the

epidemiological impact of gastric cancer – the world’s fourth leading cause of cancer-related

death.

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Халимова, Ю. С., & Хафизова, М. Н. (2024). МОРФО-ФУНКЦИОНАЛЬНЫЕ И

КЛИНИЧЕСКИЕ АСПЕКТЫ СТРОЕНИЯ И РАЗВИТИЯ ЯИЧНИКОВ (ОБЗОР

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Халимова, Ю. С. (2024). Морфологические Особенности Поражения Печени У

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TESTICULAR AND OVARIAN TISSUES OF ANIMALS IN THE AGE

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Salokhiddinovna, K. Y. (2024). IMMUNOLOGICAL CRITERIA OF REPRODUCTION

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ETHANOL.

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THE INCIDENCE OF AIDS, THE DEFINITION AND CAUSES OF THE

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43.

Nematilloevna, K. M., & Salokhiddinovna, K. Y. (2024).

IMPORTANT FEATURES IN THE

FORMATION OF DEGREE OF COMPARISON OF ADJECTIVES IN LATIN.

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FEATURES OF THE STRUCTURE

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ОТРЕЗКОВ В НАИМЕНОВАНИЯХ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ В

ФАРМАЦЕВТИКЕ.

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ОБРАЗОВАНИЕ

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Халимова, Ю. С., & Хафизова, М. Н. (2024). ОСОБЕННОСТИ СОЗРЕВАНИЕ И

ФУНКЦИОНИРОВАНИЕ

ЯИЧНИКОВ.

ОБРАЗОВАНИЕ

НАУКА

И

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Халимова, Ю. С., & Хафизова, М. Н. (2024). КЛИНИЧЕСКИЕ АСПЕКТЫ ЛИЦ

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Халимова, Ю. С., & Хафизова, М. Н. (2024). кафедра Клинических наук Азиатский

международный

университет

Бухара,

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ЗАБОЛЕВАНИЙ

ВНУТРЕННИХ

ОРГАНОВ

У

ЛИЦ,

СТРАДАЮЩИХ

АЛКОГОЛЬНОЙ ЗАВИСИМОСТЬЮ.

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