Qualitative and quantitative alterations in the parietal cell domain in chronic gastritis

Hematoxylin and eosin (H&E) is not an optimal stain to discriminate between parietal and chief cells in gastric biopsies; modified Giemsa (G) and toluidine blue (TB) were found more suitable stains to characterize these two cell phenotypes. Sixty-eight well-oriented sections from the fundic mucosa were stained with H&E, and with G or TB. With G or TB the normal fundic mucosa clearly displayed a parietal cell domain (PCD) and a chief-cell domain (CCD). The continuity of these two cell domains was assessed in the entire section at ×4 magnification and the thickness of the PCD. The total mucosal thickness (TMT) was measured in three different HPF at ×20 magnifications. Qualitative observations indicated that the PCD and CCD were (a) continuous in normal fundic mucosa or having slight chronic gastritis, (b) fragmented in moderate chronic gastritis, in focal glandular atrophy or focal IM or (c) absent in severe chronic gastritis, including autoimmune gastritis and extensive IM. Quantitative measurements showed that the thickness of the PCD in chronic gastritis could be (a) normal, (b) reduced by partial destruction of the parietal cell population by chronic inflammation, or (c) absent, in extensive IM or total glandular atrophy (p < 0.05). Toluidine blue gave a better contrast between the two cell phenotypes than modified Giemsa stain. Future studies might elucidate whether qualitative and quantitative studies of toluidine blue-stained sections of the fundic mucosa are useful in monitoring the results of therapy in individual patients with chronic gastritis.