Chronic Gastritis: Dynamic and Clinical Aspects

Abstract

A simple method for grading gastritis is to assess the severity of round cell infiltration and the loss of normal glands, and this may be applied to both antral and body changes. However, there is, as yet, no satisfactory classification of gastritis. In population samples, gastritis shows a linear increase in age-specific prevalence so that the annual increase in the body atrophic gastritis pool up to geriatric age is constant (1.5%). In the elderly, there appears to be a retardation of the process, particularly in the antral mucosa, where some healing trend is demonstrable. This dynamic behaviour is qualitatively similar in all population samples collected in Finland and Estonia. On the other hand, the dynamic behaviour of gastritis in different subpopulations differs markedly from that in the population at large. In pernicious anemia patients and their first-degree relatives, the progression of body atrophic gastritis in its final stages is about 20 times more rapid than in a general population, while, simultaneously, antral gastritis displays a distinct healing tendency. A behaviour opposite to that in pernicious anemia is seen in patients with active or healed duodenal ulcer disease and in duodenitis: antral gastritis behaves, on the whole, similarly to that in the general population, but in the body mucosa there occurs virtually no progression with age, and the mucosa generally remains normal or at the stage of superficial gastritis. However, after antrectomy body gastritis progresses rapidly in the remnant at first, but it slows down later and then closely resembles that in the general population. Gastric ulcer shows a variable behaviour so that most juxtapyloric ulcers behave dynamically like duodenal ulcers, while the angular ulcers indicate a rapid progression of body gastritis associated with a markedly slower progression of antral gastritis. It seems that the characteristics of, and variations in, antral body gastritis in the different subpopulations are related to age, the only distinct dynamic feature in common being the dissimilar and poorly co-ordinated dynamic behaviour of these stomach areas. Despite significant association with clinically important diseases, chronic gastritis shows poor correlation with different kinds of upper abdominal complaints, and it is probable that complaints which are found in connection with chronic gastritis are due to other concomitant diseases or unrelated functional disturbances.