Etiology and management of chronic gastritis

There are reasons to believe that chronic antral gastritis and chronic body gastritis are different clinical conditions. While both are associated with aging, chronic antral gastritis is much more commonly associated with gastric or duodenal ulcer. The natural history of chronic antral gastritis in asymptomatic normals and patients with peptic ulcer appears the same. Chronic body gastritis deteriorates rapidly with age in patients with gastric ulcer, but does not progress in patients with duodenal ulcer. With spontaneous healing of duodenal ulcer, chronic antral gastritis improves but persists. All these observations suggest that gastric ulcer, duodenal ulcer, and chronic antral gastritis are involved in a common mucosal inflammatory process. C. pylori occurs commonly on the antral mucosa affected by chronic gastritis, but is found to a much less extent at the site of peptic ulceration, and spontaneous ulcer healing is not affected by the presence of the organisms. It remains to be established whether C. pylori is the cause of chronic antral gastritis, is an aggravating factor of the gastritis, or is simply an inhabitant of the inflamed antral mucosa. Other known associations of chronic gastritis include pernicious anemia, bile reflux, and gastric cancer. Whether chronic antral or body gastritis is associated with clinical symptoms remains controversial. Histological improvement can be obtained with the use of prostaglandins, sucralfate, or bismuth compounds, which have one common property--they all possess mucosal-protective mechanisms.