From the Guidelines
Gastric oxyntic mucosa with chronic inactive gastritis should be managed by addressing the underlying cause, with a focus on H. pylori eradication if present, and symptom management with acid suppression using a proton pump inhibitor, as well as lifestyle modifications to reduce gastric acid production and prevent further mucosal damage. The condition is characterized by inflammation in the acid-producing region of the stomach that has persisted over time but is not currently showing active inflammatory cell infiltration, as described in the study by Shah et al. 1.
Key Considerations
- The diagnosis of atrophic gastritis (AG) should be confirmed by histopathology, which shows a gradual decrease in size and eventual disappearance of gastric glands, replaced by connective tissue or metaplastic epithelium 1.
- The standard regimen for H. pylori eradication includes a proton pump inhibitor, amoxicillin, and clarithromycin for 14 days, as this approach has been shown to be effective in treating the infection and reducing the risk of gastric cancer 1.
- Symptom management with acid suppression using a proton pump inhibitor, such as pantoprazole 40mg daily for 4-8 weeks, is recommended if H. pylori is not present, to reduce gastric acid production and prevent further mucosal damage 1.
- Lifestyle modifications, including avoiding NSAIDs, alcohol, spicy foods, and smoking, are also important to reduce gastric acid production and prevent further mucosal damage.
Treatment Approach
- H. pylori eradication is the primary approach if infection is present, as it has been shown to reduce the risk of gastric cancer and improve symptoms 1.
- Symptom management with acid suppression using a proton pump inhibitor is recommended if H. pylori is not present, to reduce gastric acid production and prevent further mucosal damage 1.
- Regular follow-up is necessary to monitor symptoms and response to treatment, and to assess the severity and topographic distribution of atrophic lesions, which are well-established determinants of gastric cancer risk 1.
Risk Assessment
- The Operative Link for Gastritis Assessment (OLGA) and Operative Link for Gastric Intestinal Metaplasia Assessment (OLGIM) are classification systems for risk assessment, which incorporate the severity and topographic distribution of atrophic lesions to predict the risk of gastric cancer 1.
- Providers should be aware that the presence of intestinal metaplasia on gastric histology almost invariably implies the diagnosis of AG, and the presence of extensive atrophy and metaplasia are associated with an increased cancer risk 1.
From the Research
Gastric Oxyntic Mucosa with Chronic Inactive Gastritis
- Chronic inactive gastritis is a condition characterized by inflammation of the gastric mucosa with minimal or no activity 2, 3.
- The oxyntic mucosa is a region of the stomach where chronic inactive gastritis can occur, and it is often associated with hyperplastic argyrophil cell changes 4.
- The main factor for gastritis progression is the presence of Helicobacter pylori infection, which can cause chronic inflammation, atrophy, and intestinal metaplasia 4, 5, 6.
Association with Helicobacter pylori Infection
- H. pylori infection is a major cause of chronic gastritis, and it can lead to atrophy and intestinal metaplasia, which are risk factors for gastric cancer 5, 6.
- The presence of H. pylori infection can influence endocrine cell populations involved in the regulation of gastric acid secretion 4.
- Chronic inactive gastritis is often associated with H. pylori infection, and the bacterium can be present in the oxyntic mucosa 2.
Effects of Proton Pump Inhibitors
- Proton pump inhibitors (PPIs) can mask H. pylori infections, leading to a diagnosis of non-H. pylori gastritis 3.
- Chronic use of PPIs can promote the diagnosis of non-H. pylori inactive chronic gastritis and increase the incidence of intestinal metaplasia 3.
- PPIs can also influence the morphology of the gastric mucosa, leading to changes in the oxyntic mucosa 4.