Lymphocytic Gastritis: an Expression of Different Diseases

Abstract

Purpose: Lymphocytic gastritis (LG) was initially believed to correspond to a nodular form of gastritis characterized by eroded depressions and described as varioliform gastritis. However, increased lymphocytic infiltrates in the gastric epithelium are also found in patients with H. pylori infection, celiac disease, microscopic colitis, and NSAID use, relegating LG to a nonspecific histopathologic pattern. The purpose of this study was to determine whether LG is a distinct nosologic entity irrespective of its associations, or represents the histopathologic manifestation of other conditions. Methods: We extracted all patients who had a histopathologic diagnosis of LG and duodenal and colonic biopsies between 1/2008 and 12/2011 from the Miraca Life Sciences database. Patients with upper gastrointestinal cancer or surgery were excluded. LG patients were divided in 3 groups: LG with H. pylori infection (LG-Hp); LG without concurrent intestinal lymphocytosis; and LG with duodenal lymphocytosis, celiac sprue, or microscopic colitis. Results: A total of 254 patients with LG were studied. Of these, 73 patients (median age 54 y; 70% F) had H. pylori infection (LG-Hp) and 181 patients (median age 63 y; 62% F) did not. Amongst the 181 H. pylori-negative patients, 58 (median age 55 y; 39% F) had no concurrent relevant duodenal or colonic conditions; the remaining 123 patients (median age 66 y; 72% F) had conditions associated with intraepithelial lymphocytosis in the small intestine, colon, or both. In these two groups, both age (p<.05) and the M:F ratio (OR 3.32 95%CI 1.73-6.36) were significantly different. Anemia was the stated indication for endoscopy in 16% of patients with LG-Hp; in 31% of those with LG and no other lymphocytosis; and in 2.4% of those with associated lymphocytic conditions (p<.0001 for all groups). In contrast, diarrhea was reported in 12% of LG-Hp patients; in 38% of those with LG only; and in 68% of patients with LG and concomitant lymphocytic conditions (p<.0001 for all groups). Both gastric and duodenal ulcers were uncommon (˜4%) and not significantly different amongst the three groups. Conclusion: Our data suggest that gastric intraepithelial lymphocytosis may not be a single disease. While it may be an expression of H. pylori infection, it may also be an epiphenomenon of intestinal conditions characterized by intraepithelial lymphocytosis and a high prevalence of diarrhea. There also appears to be a form of lymphocytosis restricted to the stomach (idiopathic LG) associated with a high prevalence of anemia in younger and predominantly male patients. Disclosure: Dr. Genta is an employee of Miraca Life Sciences, Irving, Texas. Dr. Neumann's gastrointestinal pathology fellowship was partially funded by Miraca Life Sciences, Irving, Texas.