Lymphocytic gastritis is not associated with active Helicobacter pylori infection.
BACKGROUND
Lymphocytic gastritis (LG), characterized by marked intra-epithelial lymphocytosis in the gastric mucosa, has been frequently associated with both celiac disease (CD) and H. pylori gastritis. The aim of this study was to review and correlate the morphology of LG with the presence of CD and H. pylori.


METHODS
Gastric biopsies diagnosed with LG from 1/1/2006 to 8/1/2013 at our institution and corresponding small bowel biopsies, when available, were reviewed for verification of the diagnosis and to assess for the presence of H. pylori and CD. Immunohistochemical (IHC) staining for H. pylori was performed on all gastric biopsies. Demographic, clinical, and laboratory data were obtained from the medical record.


RESULTS
Fifty-four of the 56 cases that met inclusion criteria demonstrated significant intra-epithelial lymphocytosis as the predominant histologic abnormality; however, none were associated with H. pylori infection by IHC staining. Two cases that also showed a prominent intra-epithelial and lamina propria neutrophilic infiltrate were both positive for H. pylori and were excluded from further study. Of the 36 small bowel biopsies available, 19 (53%) showed changes in CD.


CONCLUSIONS
LG is not a distinct clinicopathologic entity, but a morphologic pattern of gastric injury that can be secondary to a variety of underlying etiologies. When restricted to cases with lymphocytosis alone, LG is strongly associated with CD and not with active H. pylori infection. However, cases that also show significant neutrophilic infiltrate should be regarded as "active chronic gastritis" and are often associated with H. pylori infection. A morphologic diagnosis of LG should prompt clinical and serologic workup to exclude underlying CD.
Research Division, ProPath, 1355 River Bend Dr, Dallas, TX 75247, USA.
Jennifer A
JA
Nielsen
Cory A
CA
Roberts
Donna J
DJ
Lager
Rajesh V
RV
Putcha
Rajeev
R
Jain
Matthew
M
Lewin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005756:Gastritis / Q000150:complications / Q000209:etiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D016480:Helicobacter pylori / Q000502:physiology*; D006801:Humans; D008218:Lymphocytosis / Q000150:complications / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
celiac disease; helicobacter; lymphocytic gastritis