Classification Of Chronic Gastritis Research Articles

Classification of chronic gastritis: historical digression and current state of the issue. A review

For more than a century, physicians have noted the relationship of chronic gastritis with the development of gastric cancer, which prompted great interest in the study and systematization of chronic gastritis in order to better understand the prognosis and develop approaches for cancer prevention. The accumulated knowledge about the etiology, pathogenesis and morphology of gastritis has made it possible to coordinate the general ideas about gastritis in the classifications used by practicing physicians today, and the systems developed and implemented into practice for assessing atrophy/intestinal metaplasia (OLGA/OLGIM) undoubtedly can help the doctor in determining the tactics of curation of the patient.

The influence of selenium on the course of inflammatory diseases of the upper gastrointestinal tract in children

Background. Impaired homeostasis of the essential microelements in the body of children plays a significant role in the etiology, pathogenesis and therapy of a number of diseases. Studies on the exchange of bioelements in gastrointestinal diseases, in particular, the content of selenium (Se), have not been conducted enough. Aim: to evaluate selenium influence on the course of inflammatory diseases of the upper gastrointestinal tract in children. Materials and methods. The study included 112 school-age children with inflammatory diseases of the upper gastrointestinal tract (55 with chronic gastritis (CG), 57 with chronic gastroduodenitis (CGD)) as the main group and 20 practically healthy children of the corresponding age as the comparison group. Verification of CG and CGD diagnosis was based on clinical and endoscopic data according to the Houston modification of the Sydney classification of chronic gastritis (1996) with assessment of topography and morphology. Quantitative determination of Se in blood plasma was carried out using mass spectrometry. Results. The average level of Se in blood plasma of children with inflammation of the gastric and duodenal mucosa was (75.82 ± 11.23) μg/l, in children of the comparison group — (85.42 ± 9.44) μg/l (p > 0.05). We did not find gender and age differences in Se plasma levels. Deficiency of Se in the blood of children with CG and CGD was found in 78 cases (69.6 %), while in the comparison group, a decrease in Se level was observed in only 4 children (20 %). There were no significant differences in the content of Se in children with CG and CGD. However, the analysis of indicators depending on the activity of the inflammatory process revealed probable differences: with the first degree of the activity of the inflammatory process in the mucous membrane, the level of Se in the blood plasma was significantly lower ((66.2 ± 6.1) μg/ml), while with the second it was (78.5 ± 7.3) μg/ml (p < 0.05) and with the third — (86.9 ± 9.3) μg/ml (p < 0.01). Conclusions. The concentration of selenium, the essential trace element, in the blood plasma of children with chronic inflammatory diseases of the upper gastrointestinal tract was found to be probably lower than that of healthy children. The level of selenium in the blood plasma of these children probably positively correlated with the degree of inflammation in the mucous membrane of the gastroduodenal region. Changes in the concentration of selenium can affect the general condition of children, the duration and severity of the disease, which must be taken into account during the treatment of inflammatory diseases.

Histopathological Diagnosis System for Gastritis Using Deep Learning Algorithm

Objective To develope a deep learning algorithm for pathological classification of chronic gastritis and assess its performance using whole-slide images (WSIs). Methods We retrospectively collected 1,250 gastric biopsy specimens (1,128 gastritis, 122 normal mucosa) from PLA General Hospital. The deep learning algorithm based on DeepLab v3 (ResNet-50) architecture was trained and validated using 1,008 WSIs and 100 WSIs, respectively. The diagnostic performance of the algorithm was tested on an independent test set of 142 WSIs, with the pathologists' consensus diagnosis as the gold standard. Results The receiver operating characteristic (ROC) curves were generated for chronic superficial gastritis (CSuG), chronic active gastritis (CAcG), and chronic atrophic gastritis (CAtG) in the test set, respectively. The areas under the ROC curves (AUCs) of the algorithm for CSuG, CAcG, and CAtG were 0.882, 0.90S and 0.910, respectively. The sensitivity and specificity of the deep learning algorithm for the classification of CSuG, CAcG, and CAtG were 0.790 and 1.000 (accuracy 0.880), 0.985 and 0.829 (accuracy 0.901), 0.952 and 0.992 (accuracy 0.986), respectively. The overall predicted accuracy for three different types of gastritis was 0.867. By flagging the suspicious regions identified by the algorithm in WSI, a more transparent and interpretable diagnosis can be generated. Conclusion The deep learning algorithm achieved high accuracy for chronic gastritis classification using WSIs. By pre-highlighting the different gastritis regions, it might be used as an auxiliary diagnostic tool to improve the work efficiency of pathologists.

Changes of 18 F-fluoro-2-deoxyglucose position-emission tomography findings by the eradication of Helicobacter pylori in the stomach.

Helicobacter pylori (HP) infection is reported to increase 18 F-fluoro-2-deoxyglucose (FDG) accumulation in the stomach. The accumulation of FDG by positron-emission tomography (FDG-PET) in the stomach for the voluntary health examinees of cancer checkup was examined before and after the HP eradication. From March 2013 to October 2015, eighty-one subjects were performed FDG-PET to detect cancer at the health checkup. All of them were also surveyed by esophagogastroduodenoscopy. Subjects were classified as the 33 cases of HP positive (group A), 38 cases of originally negative (group B), and the 10 negative cases by HP eradication therapy (group C). Group A was treated by combination of amoxicillin, clarithromycin, and proton pump inhibitor for a week, and all of them eradicated HP. A part of group A (n=7) was serially performed FDG-PET one to five years after the treatment and compared the maximum standard uptake value of FDG (SUV) around the fundic gland region. SUV of group A (3.55±0.69) was significantly higher than those of both group B (2.96±0.72) and group C (2.89±0.51) (p<0.01, respectively). Groups B and C are almost comparable and showed no significant difference during the course. In group A, HP eradication significantly decreased the SUV to 3.1±0.43 (P<.01). SUV after the eradication was significantly reduced (P<.01) in the mild to moderate atrophy (C1-C3) group according to Kimura and Takemoto classification of chronic gastritis of group A. Although SUV in the advanced atrophy group (O1-O3) tended to decline after the eradication, the change was not significant. HP-infected stomach showed higher FDG uptake in the fundic gland region and HP eradication decreased the uptake in the mild to moderate atrophic gastritis but not in the severe atrophic gastritis.

Systematic review and Meta-analysis of efficacy and safety of Xiangsha Yangwei Pills in treatment of chronic gastritis

To systematically evaluate the efficacy and safety of Xiangsha Yangwei Pills in the treatment of chronic gastritis. Compu-ter retrieval was performed for Cochrane Library, Medline, EMbase, China Knowledge Network Database(CNKI), China Biomedical Literature Service System(SinoMed), Chongqing Weipu Chinese Science and Technology Journal Database(VIP) and WanFang Database(WanFang) randomized controlled trials about Xiangsha Yangwei Pills combined with Western medicine in the treatment of chro-nic gastritis. The retrieval time ranged from the establishment of the library to April 26, 2019. Meta-analysis was performed by RevMan 5.3 software after two independent researchers conducted literature screening, data extraction and quality evaluation according to inclusion and exclusion criteria. A total of 1 720 patients were enrolled in 18 RCT. According to the classification of chronic gastritis, they were divided into three subgroups: chronic gastritis, chronic atrophic gastritis and chronic superficial gastritis. The results of Meta-ana-lysis showed that the efficacy of Xiangsha Yangwei Pills combined with Western medicine in treating chronic gastritis was higher than that of Western medicine. As for the recurrence rate, Xiangsha Yangwei Pills combined with Western medicine was lower than Western medicine. And there was no statistical difference about helicobacter pylori(Hp) eradication rate between Xiangsha Yangwei Pills combined with Western medicine as well as Western medicine. In terms of the incidence of adverse reactions, Xiangsha Yangwei Pills combined with Western medicine was lower than Western medicine, and no serious adverse reaction was reported. The results of this systematic review showed that compared with the conventional Western medicine group, Xiangsha Yangwei Pills combined with Western medicine can significantly alleviate clinical symptoms of chronic gastritis, with fewer adverse reactions. However, due to the low methodological quality of the included studies and the reliability of the impact conclusions, high-quality multi-center, large-sample, randomized, double-blind controlled trials are needed for validation.

Histopathological Diagnosis System for Gastritis Using Deep Learning Algorithm.

Objective To develope a deep learning algorithm for pathological classification of chronic gastritis and assess its performance using whole-slide images (WSIs). Methods We retrospectively collected 1,250 gastric biopsy specimens (1,128 gastritis, 122 normal mucosa) from PLA General Hospital. The deep learning algorithm based on DeepLab v3 (ResNet-50) architecture was trained and validated using 1,008 WSIs and 100 WSIs, respectively. The diagnostic performance of the algorithm was tested on an independent test set of 142 WSIs, with the pathologists' consensus diagnosis as the gold standard. Results The receiver operating characteristic (ROC) curves were generated for chronic superficial gastritis (CSuG), chronic active gastritis (CAcG), and chronic atrophic gastritis (CAtG) in the test set, respectively.The areas under the ROC curves (AUCs) of the algorithm for CSuG, CAcG, and CAtG were 0.882, 0.905 and 0.910, respectively. The sensitivity and specificity of the deep learning algorithm for the classification of CSuG, CAcG, and CAtG were 0.790 and 1.000 (accuracy 0.880), 0.985 and 0.829 (accuracy 0.901), 0.952 and 0.992 (accuracy 0.986), respectively. The overall predicted accuracy for three different types of gastritis was 0.867. By flagging the suspicious regions identified by the algorithm in WSI, a more transparent and interpretable diagnosis can be generated. Conclusion The deep learning algorithm achieved high accuracy for chronic gastritis classification using WSIs. By pre-highlighting the different gastritis regions, it might be used as an auxiliary diagnostic tool to improve the work efficiency of pathologists.

Kyoto consensus — a new etiological classification of chronic gastritis and its discussion

The article provides a detailed analysis of the provisions of the Kyoto consensus on the classification of chronic gastritis. Particular attention is paid to the etiological role of Helicobacter pylori. The authors presented the results of their own study of the microbial “landscape” of the gastric mucosa. The role of Helicobacter pylori, atrophy and metaplasia of the gastric mucosa in the development of gastric cancer, as well as other etiological variants of chronic gastritis: alcoholic, medicinal, etc. are discussed. Critical assessment of the main provisions of the Kyoto consensus was made.

Kyoto consensus - the new etiological classification of chronic gastritis and its discussion

The main provisions and headings of the new etiological classification of chronic gastritis are discussed in the context of recent data on the true role of Helicobacter pylori infection in the development of this pathology. The methods and results of the authors ’ investigations into gastric microflora are presented along with information about the frequency of detection of its different forms, concentration of microbial forms in gastric mucosa, their pathogenic properties including urease activity, and possible contribution to chronic gastritis etiology. The possibility of alcoholic and chemical chronic gastritis is discussed along with the role of these conditions in the development of stomach cancer. Special emphasis is laid on the disagreement between the adopted consensuses and principles of evidence-based medicine.

Topical problems of chronic gastritis

The authors propose the definition of chronic gastritis with a brief overview of the history of investigation of this diseases and its prevalence with special reference to (1) the bacterial profile and its role in the development of infectious and inflammatory process in gastric mucosa, (2) the modern state of and new trends in the classification of chronic gastritis including their advantages and disadvantages, (3) the relationship between chronic gastritis and functional gastroduodenal dyspepsia syndrome. It is concluded that mucous microflora plays an important factor in the development ofpathology but H.pylori is not its predominant component. Modern classifications of chronic gastritis provide a basis for a deeper insight into evolution of chronic gastritis and its transformation into cancer. The diagnosis of ‘chronic gastritis with functional gastroduodenal dyspepsia syndrome‘ is invalid.

Kyoto global consensus report on Helicobacter pylori gastritis

ObjectiveTo present results of the Kyoto Global Consensus Meeting, which was convened to develop global consensus on (1) classification of chronic gastritis and duodenitis, (2) clinical distinction of dyspepsia caused...

Source of variation in the diagnosis of Helicobacter pylori-associated multifocal atrophic gastritis.

Introduction: Multiple sampling from different sites of the stomach as well as the number of fragments of gastric mucosa available for histopathologic evaluation are important sources of variation when classifying and grading chronic gastritis. Objective: To estimate the sensitivity of the number of fragments of gastric mucosa necessary to establish the diagnosis of atrophic gastritis with intestinal metaplasia, gastric dysplasia and H. pylori infection. In addition, this study will attempt to assess the intra-observer variability in the classification of these premalignant gastric lesions. Methods: This is a 6 year-cohort study, wherein 1958 gastric endoscopic procedures performed by two gastroenterologists were reviewed. Five gastric biopsy samples were obtained from the antrum, body and lesser curvature during each procedure. One pathologist was in charge of reviewing the five histopathology samples for each subject and providing a definitive diagnosis which was used as the gold standard. Each gastric mucosa sample reviewed led to an individual diagnosis for that sample which was compared with the gold standard. Intra-observer variability was assessed in 127 individuals who correspond to a random sample of 20% of the total endoscopic procedures performed during the 72 month-follow-up. Results: The sensitivity of the diagnosis of intestinal metaplasia (IM) and gastric dysplasia increased proportionally with the number of gastric mucosa samples reviewed. The lesser curvature of the stomach had the highest sensitivity for the diagnosis of IM and dysplasia, among all the stomach regions studied. Just one sample of gastric mucosa attained a sensitivity of 95.9% for the detection of H. pylori infection. The intra-observer agreement for the diagnosis of multifocal atrophic gastritis was 86.1% and the kappa value was 0.79 (95% CI 0.76-0.85). Alcohol-fixed biopsy specimens were inadequate to diagnose H. pylori infection and to assess dysplasia. Conclusion: The number of mucosa gastric fragments reviewed, the fixation method used, and the biopsy site are all important factors in order to ensure a correct classification of chronic gastritis.

Relationship between the Diagnostic Approach to the Gastric Cancer and the Classification of Chronic Gastritis in the Upper Gastrointestinal Series

Relationship between the Diagnostic Approach to the Gastric Cancer and the Classification of Chronic Gastritis in the Upper Gastrointestinal Series

Correlation between CD4, CD8 cell infiltration in gastric mucosa,Helicobacter pyloriinfection and symptoms in patients with chronic gastritis

To evaluate the correlation between CD4, CD8 cell infiltration in gastric mucosa, Helicobacter pylori (H pylori) infection and symptoms or the assemblage of symptoms in cases with chronic gastritis. Biopsy samples at the gastric antrum were obtained from 62 patients with chronic gastritis. CD4 and CD8 cell infiltration was evaluated by immunohistochemical assays on frozen sections of the biopsy samples. Fifteen symptoms referring to digestion-related activity and non-digestion related activity were observed. The correlation between lymphocyte infiltration and each symptom or symptom assemblage was analyzed by logistic regression and K-mean cluster methods. CD4 cell infiltrations in gastric mucosa were much more in patients with H. pylori infection, while CD8 cell infiltrations were similar in patients with or without H. pylori infection. Logistic regression analysis showed that the symptoms including heavy feeling in head or body (t = 2.563), and thirst (t = 2.478) were significantly related with CD4 cell infiltration in gastric mucosa (P<0.05), and cool limbs with aversion to cold were related with CD8 cell infiltration (t = 2.872, P<0.05). Further analysis showed that non-digestive related symptom assemblage could increase the predicted percentage of CD4 and CD8 cell infiltration in gastric mucosa, including lower CD4 infiltration by 12.5%, higher CD8 infiltration by 33.3%, and also non-H. pylori infection by 23.6%. K-means cluster analysis of all symptoms and CD4 and CD8 cell infiltration in gastric mucosa showed a similar tendency to increase the predicted percentage of CD4, CD8 cell infiltration and H. pylori infection. Based on correlation between the gastric mucosa lymphocyte infiltration, H. pylori infection and clinical symptoms, symptoms or symptomatic assemblages play an important role in making further classification of chronic gastritis, which might help find a more specific therapy for chronic gastritis.

Study on the classification of chronic gastritis at molecular biological level.

To explore the pathophysiologibasis for the fact that patients with digestive tract symptoms do not necessarily have gastric mucosal pathology and those without clinical symptoms do not necessarily have no gastric mucosal pathology. The ultrastructure, trace elements, cAMP, DNA, SOD and LPO in the gastric mucosa and its epithelial cells of 188 patients without organic lesions of heart, lung, liver, gallbladder, pancreas, kidney or intestine and basically histopathological normal persons (F) were detected synchronously by SEM, TEM, EDAX, Image analysis system RIA and (3)H-TdR Lymphocyte Transfer Test. The content of Zn, Cu, cAMP and (3)H-TdR LCT in gastric mucosa and the content of Zn, Cu, DNA and LPO in gastric mucosa epithelial nuclei of each group were shown as belows: Normal control (4.1+/-1.0, 5.2+/-0.8, 15.9+/-1.5, 1079.7+/-227.4, 7.6+/-0.4, 58.4+/-0.3, 12.6+/-2.7, 2.6+/-0.6); CSG without symptoms group (3.7+/-1.2, 5.1+/-1.8, 15.6+/-0.9, 924.5+/-234.9, 7.8+/-0.3, 58.6+/-0.4, 13.0+/-3.1, 2.9+/-0.4); CAG without symptoms group (3.3+/-1.0, 4.8+/-0.9, 14.9+/-0.7, 887.7+/-243.6, 7.8+/-0.3, 58.7+/-0.3, 14.3+/-2.8, 3.1+/-0.4); F type with symptoms group (3.5+/-1.4, 4.5+/-1.0, 15.7+/-1.4, 932.1+/-2449.3, 7.9+/-0.4, 58.7+/-0.5, 13.5+/-4.6, 2.9+/-0.7); CSG with symptoms group (2.8+/-1.9, 4.0+/-1.5, 14.2+/-1.8, 867.3+/-240.5, 8.1+/-0.5, 58.9+/-0.5, 15.2+/-3.2, 4.2+/-0.7); CAG with symptoms group (2.0+/-1.8, 3.4+/-1.5, 13.4+/-1.8, 800.9+/-221.8, 8.6+/-0.4, 59.3+/-0.5, 16.5+/-3.1, 4.5+/-0.6). The contents of Zn, Cu in mitochonondria and SOD in gastric mucosa of each group were shown as belows: Normal control group (9.2+/-0.5, 58.3+/-0.3, 170.5+/-6.1), CSG without symptoms group (8.9+/-0.5, 58.2+/-0.3, 167.2+/-5.3), CAG without symptoms group (8.8+/-0.4, 57.5+/-0.2, 166.1+/-4.2); F type with symptoms group (8.9+/-0.5, 58.0+/-0.3, 167.9+/-5.7), CSG with symptoms group (8.6+/-0.5, 57.8+/-0.3, 163.3+/-5.6); CAG with symptoms group (8.3+/-0.4, 57.5+/-0.3, 161.2+/-4.3). There were significant differences in these cases, P<0.05-0.001. There were synchronous changes of gastric mucosa epithelial cellular ultrastructure. The "background lesions" (focal atrophic gastritis, focal intestinal metaplasia, micro-ulcer) in nonfocal gastric mucosa of all groups had significant differences (P<0.05-0.001). Disease with symptoms, disease without symptoms, nondisease with symptoms occur on the basis of the quantitative changes of gastric mucosa epithelial cellular ultrastructure and related bioactive substances.

Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis.

Various types of classification of gastritis have been proposed, but no plausible classification has been available until now. The Research Society for Gastritis performed a pilot study to establish an endoscopic classification, taking into consideration the following: (i) ease of use; (ii) permitting everyone the common image; and (iii) presence of histopathological evidence. One hundred and fifty-five patients were enrolled and underwent gastroscopy. Eight basic endoscopic and histological types of gastritis (superficial, hemorrhagic, erosive, verrucous, atrophic, metaplastic, hyperplastic and special types) were defined. Gastritis was endoscopically diagnosed according to the definition of the endoscopic types of gastritis. Four or more biopsy specimens were obtained from the lesser and the greater curvatures of the antrum and the corpus of each patient, and the histological findings of gastritis and Helicobacter pylori infection were assessed. The histological diagnosis of gastritis was made according to the definition of histology types of gastritis. The endoscopic and the histological diagnoses were then compared in a blinded fashion. Endoscopic diagnosis was 62% as sensitive as histological diagnosis for erosive gastritis, 67% for verrucous gastritis and 84% for atrophic gastritis in the antrum. In superficial gastritis, sensitivity was approximately 25% in the corpus, but only 8% in the antrum. Metaplastic and hyperplastic gastritis were correctly diagnosed only in severe cases. Five basic types of gastritis (superficial, erosive, verrucous, atrophic and special types) should be employed for the new endoscopic gastritis classification. Metaplastic and hyperplastic gastritis are considered to be subtypes of atrophic gastritis and they should be excluded from the basic endoscopic classification. A new definition of gastritis in the antrum accompanied by redness still remains to be investigated.

Helicobacter pylori associated gastric diseases and lymphoid tissue hyperplasia in gastric antral mucosa.

To investigate the relation between Helicobacter pylori associated gastroduodenal diseases and lymphoid tissue hyperplasia in the antral mucosa and to pursue its evolution after eradication of H pylori. Gastric antral biopsy specimens were obtained from 438 patients with H pylori positive gastroduodenal diseases (185 chronic gastritis, 69 gastric ulcer, and 184 duodenal ulcer) and 50 H pylori negative healthy controls. Lymphoid follicles and aggregates were counted and other pathological features were scored according to the updated Sydney system for classification of chronic gastritis. After a course of anti-H pylori treatment, biopsy specimens were obtained at four to six weeks, 12 months, and 24 months in the chronic gastritis patient group. The total prevalence of lymphoid follicles and aggregates in the biopsies was 79.9% (350 of 438; 95% confidence intervals (CI), 0.76 to 0.84). The prevalence and density of lymphoid follicles and aggregates were significantly different in the various gastroduodenal diseases. The highest prevalence (89.9%; 95% CI, 0.83 to 0.97) and density (0.82) of lymphoid follicles and aggregates occurred in patients with gastric ulcers. The lowest prevalence of lymphoid follicles and aggregates was found in patients with chronic gastritis (74.6%; 95% CI, 0.68 to 0.81), and the lowest density of lymphoid follicles and aggregates (0.56) was seen in patients with duodenal ulcers. The prevalence and density of lymphoid follicles and aggregates correlated strongly with the activity and severity of gastric antral mucosal inflammation. The eradication of H pylori resulted in a decrease in the prevalence and density of lymphoid follicles and aggregates. The prevalence and density of lymphoid follicles and aggregates in gastric antral mucosal biopsies correlated closely with H pylori infection.

Influence of Helicobacter pylori Colonization on Histological Grading of Chronic Gastritis in Korean Patients with peptic Ulcer

Objectives:We conducted an analysis of correlation between histological grading of chronic gastritis and the presence of H. pylori infection to investigate if H. pylori influences histological severity of chronic gastritis in Korean patients with peptic ulcers.Methods:Gastroscopic antral biopsy specimens and peripheral venous blood were taken from 80 patients with gastric or duodenal ulcers. H. pylori was identified microscopically in sections with Giemsa staining and quantitative grading of cultured H. pylori was reported on a scale 0 to 3. The histopathological features of biopsy specimens were reported according to the Sydney classification of chronic gastritis. Serum gastritis and pepsinogen concentrations were measured by radioimmunoassay.Results:H. pylori was identified in 62.5% (20 of 32 GU, 30 of 48 DU) of the study group. Gastric clonization rate of H. pylori did not increased with age. Forty of 50 biopsy specimens with H. pylori and also 23 of 30 biopsy specimens without H. pylori showed active chronic gastritis. There was no significant correlation overall between the presence of H. pylori and histological grading of chronic gastritis, including activity, and also no association was found between the quantitative grading of H. pylori and the histological grading of chronic gastritis. With and without H. pylori, a mean of serum gastritis concentration (79.4±43.0 pg/ml and 80.2±31.9 pg/ml) showed no significant difference, but a mean of serum pepsinogen concentration (87.7±41.6 ng/ml and 119±34.4 ng/ml) showed significant difference between the populations with and without H. pylori (p=0.001)Conclusions:The influence of H. pylori on histological grading of chronic gastritis in Korean is less than that in prior studies of Western countries, and further investigation of pathogenesis of H. pylori in chronic gastritis and peptic ulceration is necessary.

Pathogenetic classification of chronic gastritis

The authors propose a simple pattern for the classification of chronic gastritis, which takes into consideration the morphologic aspects involved in a distinct pathogenic process. This flexible and simple classification may be useful to both pathologists and clinicians.

Clinical Trials as Etiologic Research Tools inHelicobacter-Associated Gastritis

The role of clinical trials as tools to elucidate the etiology of chronic gastritis is discussed. Three areas are briefly explored. The first one concerns the classification of chronic gastritis, a constellation of interconnected nosologic entities. The second refers to the histopathologic factors of chronic gastritis; preliminary results show that clearance of Helicobacter pylori decreases the inflammatory infiltrate and suggest that H. pylori alters cell ploidy. The third area refers to the multifactorial etiology of chronic gastritis and the role that clinical trials could play in its elucidation.

Towards a new classification of chronic gastritis

Towards a new classification of chronic gastritis