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Granulomatous gastritis

INTRODUCTION

A granuloma is an organized aggregation of combined histiocytic, lymphocytic, and plasma infiltrate (granulomatous inflammation). When this organized collection of cells is identified in the stomach, it is referred to as granulomatous gastritis.

This topic review will discuss the epidemiology, etiology, histopathology, and diagnosis of granulomatous gastritis. The classification of gastritis and causes of acute and chronic gastritis are presented separately. (See "Classification and diagnosis of gastritis and gastropathy" and "Acute and chronic gastritis due to Helicobacter pylori".)

EPIDEMIOLOGY

Granulomatous gastritis is rare, with an incidence of 0.08 to 0.35 percent of gastritis cases [1-4]. In the largest reported series, only 56 cases were diagnosed after review of 15,947 biopsies/resections [5].

ETIOLOGY

Granulomatous gastritis is a subtype of chronic gastritis and can be subclassified based on the etiology into infectious, noninfectious, and idiopathic granulomatous gastritis [5].

A specific cause can be identified in most patients found to have granulomatous gastritis [2,6]. The most likely causes vary by geography and ethnicity. Most cases of granulomatous gastritis in the western hemisphere are noninfectious in etiology with the most common causes in adults and children being Crohn disease and sarcoidosis [2,3]. In contrast, in developing countries, infectious diseases, particularly Mycobacterium tuberculosis, are the most common cause of granulomatous gastritis [7].

              

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Literature review current through: Nov 2014. | This topic last updated: Oct 24, 2013.
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References
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  1. Shapiro JL, Goldblum JR, Petras RE. A clinicopathologic study of 42 patients with granulomatous gastritis. Is there really an "idiopathic" granulomatous gastritis? Am J Surg Pathol 1996; 20:462.
  2. Ectors NL, Dixon MF, Geboes KJ, et al. Granulomatous gastritis: a morphological and diagnostic approach. Histopathology 1993; 23:55.
  3. Maeng L, Lee A, Choi K, et al. Granulomatous gastritis: a clinicopathologic analysis of 18 biopsy cases. Am J Surg Pathol 2004; 28:941.
  4. FAHIMI HD, DEREN JJ, GOTTLIEB LS, ZAMCHECK N. ISOLATED GRANULOMATOUS GASTRITIS: ITS RELATIONSHIP TO DISSEMINATED SARCOIDOSIS AND REGIONAL ENTERITIS. Gastroenterology 1963; 45:161.
  5. Genta RM. Granulomatous gastritis. In: Gastritis, Graham DY, Genta RM, Dixon MF (Eds), Lippincott Williams & Wilkins, Philadelphia 1999.
  6. Sepulveda AR, Patil M. Practical approach to the pathologic diagnosis of gastritis. Arch Pathol Lab Med 2008; 132:1586.
  7. Kamani L, Mumtaz K, Azad NS, Jafri W. Granulomatous gastritis: a diagnostic dilemma? Singapore Med J 2008; 49:e222.
  8. Renault M, Goodier A, Subramony C, et al. Age-related differences in granulomatous gastritis: a retrospective, clinicopathological analysis. J Clin Pathol 2010; 63:347.
  9. Oberhuber G, Püspök A, Oesterreicher C, et al. Focally enhanced gastritis: a frequent type of gastritis in patients with Crohn's disease. Gastroenterology 1997; 112:698.
  10. Wright CL, Riddell RH. Histology of the stomach and duodenum in Crohn's disease. Am J Surg Pathol 1998; 22:383.
  11. Xin W, Greenson JK. The clinical significance of focally enhanced gastritis. Am J Surg Pathol 2004; 28:1347.
  12. Owen DA. Gastritis and carditis. Mod Pathol 2003; 16:325.
  13. Vahid B, Spodik M, Braun KN, et al. Sarcoidosis of gastrointestinal tract: a rare disease. Dig Dis Sci 2007; 52:3316.
  14. Dulai PS, Rothstein RI. Disseminated sarcoidosis presenting as granulomatous gastritis: a clinical review of the gastrointestinal and hepatic manifestations of sarcoidosis. J Clin Gastroenterol 2012; 46:367.
  15. Lauwers GY. Gastritis: beyond Helicobacter pylori. Int J Surg Pathol 2010; 18:28S.
  16. Ozturk Y, Buyukgebiz B, Ozer E, et al. Resolution of Helicobacter pylori associated granulomatous gastritis in a child after eradication therapy. J Pediatr Gastroenterol Nutr 2004; 39:286.
  17. Miyamoto M, Haruma K, Yoshihara M, et al. Isolated granulomatous gastritis successfully treated by Helicobacter pylori eradication: a possible association between granulomatous gastritis and Helicobacter pylori. J Gastroenterol 2003; 38:371.
  18. Genta RM, Lash RH. Helicobacter pylori-negative gastritis: seek, yet ye shall not always find. Am J Surg Pathol 2010; 34:e25.
  19. Srivastava A, Lauwers GY. Pathology of non-infective gastritis. Histopathology 2007; 50:15.
  20. Kim YS, Lee HK, Kim JO, et al. A Case of H. pylori-associated Granulomatous Gastritis with Hypertrophic Gastropathy. Gut Liver 2009; 3:137.
  21. Yamane T, Uchiyama K, Ishii T, et al. Isolated granulomatous gastritis showing discoloration of lesions after Helicobacter pylori eradication. Dig Endosc 2010; 22:140.
  22. Lauwers GY, Fujita H, Nagata K, Shimizu M. Pathology of non-Helicobacter pylori gastritis: extending the histopathologic horizons. J Gastroenterol 2010; 45:131.
  23. Sandmeier D, Bouzourene H. Does idiopathic granulomatous gastritis exist? Histopathology 2005; 46:352.
  24. Besses C, Sans-Sabrafen J, Badia X, et al. Ulceroinfiltrative syphilitic gastropathy: silver stain diagnosis from biopsy specimen. Am J Gastroenterol 1987; 82:773.
  25. Beckman JW, Schuman BM. Antral gastritis and ulceration in a patient with secondary syphilis. Gastrointest Endosc 1986; 32:355.
  26. Anai H, Okada Y, Okubo K, et al. Gastric syphilis simulating linitis plastica type of gastric cancer. Gastrointest Endosc 1990; 36:624.
  27. Niitsu H, Tanabe K, Tokumoto N, et al. Idiopathic granulomatous gastritis resembling a gastrointestinal stromal tumor. Case Rep Gastroenterol 2012; 6:502.
  28. Tsukada T, Nakano T, Miyata T, et al. Xanthogranulomatous gastritis mimicking malignant GIST on F-18 FDG PET. Ann Nucl Med 2012; 26:752.
  29. Kinoshita H, Yamaguchi S, Sakata Y, et al. A rare case of xanthogranuloma of the stomach masquerading as an advanced stage tumor. World J Surg Oncol 2011; 9:67.
  30. Munker M, Sharma OP. Fatal gastrointestinal haemorrhage in sarcoidosis: a previously unreported occurrence. Sarcoidosis 1987; 4:55.
  31. Akinyemi E, Rohewal U, Tangorra M, Abdullah M. Gastric sarcoidosis. J Natl Med Assoc 2006; 98:948.
  32. Gumaste VV, Janowitz HD, Waye JD. Granulomatous gastritis: a case report and review of the literature. Am J Gastroenterol 1989; 84:1315.