- Chronic active gastritis is a form of long-standing inflammation of the gastric mucosa that is characterized histologically by the persistent presence of inflammatory cells, particularly lymphocytes and plasma cells, along with neutrophilic infiltration. The term “active” refers to the ongoing recruitment of neutrophils, which indicates continued mucosal injury. This distinguishes it from purely chronic gastritis, where neutrophilic activity may be minimal or absent.
- One of the most common causes of chronic active gastritis is infection with Helicobacter pylori, a spiral-shaped, Gram-negative bacterium that colonizes the gastric mucosa. The bacterium induces both acute and chronic inflammatory responses, leading to mucosal damage over time. The neutrophils actively infiltrate the epithelial layer and the gastric pits, sometimes forming microabscesses, while the chronic component includes deeper infiltration of lymphocytes and plasma cells in the lamina propria.
- Clinically, chronic active gastritis may be asymptomatic in many individuals, especially in early stages. However, in symptomatic cases, patients may present with dyspepsia, epigastric pain, nausea, or bloating. If left untreated, chronic inflammation can lead to mucosal atrophy (atrophic gastritis), intestinal metaplasia, and increase the risk of peptic ulcer disease or even gastric adenocarcinoma, particularly in the context of long-standing H. pylori infection.
- Diagnosis typically involves endoscopic examination with biopsy, followed by histological evaluation of the gastric tissue. The presence of both mononuclear and neutrophilic infiltrates confirms the diagnosis of chronic active gastritis. Special staining techniques (such as Giemsa or Warthin-Starry) or immunohistochemistry may be used to detect H. pylori. Non-invasive diagnostic methods include urea breath test, stool antigen test, and serology, but histology remains the gold standard in many cases.
- Management involves eradication of H. pylori if present, usually through combination antibiotic therapy along with a proton pump inhibitor. Once the infection is cleared, the inflammatory activity usually subsides, and mucosal healing can occur. Long-term follow-up may be needed in patients with complications or significant mucosal changes.
- In summary, chronic active gastritis represents a dynamic and persistent inflammatory condition of the stomach lining, most commonly driven by H. pylori infection. Recognizing and treating this condition is important not only for symptom relief but also for preventing its potential progression to more serious gastric diseases.
