Injury to the gastric mucosa is associated with epithelial cell damage and regeneration. The term gastritis is used to denote inflammation associated with mucosal injury. However, epithelial cell injury and regeneration are not always accompanied by mucosal inflammation. This distinction has caused considerable confusion since gastritis is often used to describe endoscopic or radiologic characteristics of the gastric mucosa rather than specific histologic findings. Epithelial cell damage and regeneration without associated inflammation is referred to as "gastropathy" [1,2]. (See "Classification and diagnosis of gastritis and gastropathy".)
The causes, natural history, and therapeutic implications of gastropathy differ from gastritis:
- Gastropathy is usually caused by irritants such as drugs (eg, nonsteroidal antiinflammatory agents), alcohol, bile, circulatory failure, and chronic congestion.
- Gastritis is usually due to infectious agents (such as Helicobacter pylori [H. pylori]) and autoimmune and hypersensitivity reactions.
Most classification systems distinguish acute, short-term from chronic, long-term disease. The terms acute and chronic are also used to describe the type of inflammatory cell infiltrate. Acute ("active") inflammation is usually associated with neutrophilic infiltration, while chronic inflammation is usually characterized by mononuclear cells, chiefly lymphocytes, plasma cells and macrophages. A practical clinicopathologic framework for the classification of gastritis and gastropathy based upon these factors can be proposed (table 1) .
Acute and chronic gastritis due to H. pylori will be reviewed here [3,4]. Although described separately, most patients with H. pylori infection will show features of both acute and chronic gastritis. The other forms of gastritis and gastropathy and other issues related to H. pylori are discussed separately. (See "Classification and diagnosis of gastritis and gastropathy" and "Indications and diagnostic tests for Helicobacter pylori infection" and "Treatment regimens for Helicobacter pylori" and "Association between Helicobacter pylori infection and gastrointestinal malignancy" and "Association between Helicobacter pylori infection and duodenal ulcer" and "Helicobacter pylori and gastroesophageal reflux disease" and "Pathophysiology of and immune response to Helicobacter pylori infection".)