What is Erosive Gastritis?
Erosive gastritis is a gastric mucosal disorder characterized by shallow erosions (breaks in the mucosal surface) with surrounding mucosal elevation, typically appearing as small erythematous nodules (3-11 mm) with central ulcerations, most commonly affecting the gastric antrum and body. 1
Clinical Presentation
Erosive gastritis presents with nonspecific upper gastrointestinal symptoms that overlap significantly with peptic ulcer disease:
- Epigastric pain (68% of patients) - the most common symptom 2
- Abdominal distension (62.6%) 2
- Postprandial fullness (47.5%) 2
- Anorexia and weight loss in some cases 3, 4
- Upper GI bleeding - can manifest as hematemesis or melena 1
The symptoms are indistinguishable from peptic ulceration, making endoscopic diagnosis essential 3.
Diagnostic Features
Endoscopic Appearance
The characteristic endoscopic findings include:
- Small erythematous nodules with shallow central erosions 4
- Lesions distributed along rugal folds 4
- 72% of erosions occur in the antrum, with 51% having multiple lesions 2
- 67% present as superficial flat lesions 2
Radiologic Appearance
On double-contrast upper GI studies:
- Target lesions: 3-11 mm nodules with central barium collections 4, 5
- Mucosal mounds numbering 3-27 per examination 5
- Linear erosions up to 15 mm in length may be present 5
CT Findings (when incidentally discovered)
CT may show 6:
- Gastric wall thickening due to submucosal edema
- Mucosal hyperenhancement from inflammation
- Focal outpouching of mucosa from ulcerations
- Fluid along the gastroduodenal region
Pathophysiology and Etiology
Histopathologic Features
Biopsy specimens reveal 3:
- Pseudopyloric metaplasia
- Pyloric gland hyperplasia
- Acute and chronic inflammation with predominance of plasma cells (not polymorphonuclear leukocytes as in peptic ulcer disease) 4
- Edema and fibrosis
- Atypia may be present and can be misinterpreted as intramucosal carcinoma 3
Associated Factors
- Helicobacter pylori infection - present in only 47% of cases 7
- NSAID use - common association 1, 7
- Gastric irritants, viral infection, and Crohn's disease are possible etiologic factors 5
- In H. pylori-positive patients, erosive gastritis shows antral-predominant gastritis evolution, similar to duodenal ulcer phenotype 8
Important Clinical Distinctions
Differentiation from Other Conditions
- Not the same as acute erosive gastritis - chronic erosive gastritis is a distinct entity with different pathology 9
- Different from peptic ulcer disease - fewer polymorphonuclear leukocytes and plasma cell predominance in the inflammatory infiltrate 4
- Must be distinguished from atrophic gastritis - atrophic gastritis involves loss of gastric glands with or without metaplasia 10
Association with Other Conditions
- Significant association with duodenal ulceration (2.8% incidence in endoscopy series) 9
- Can coexist with gastric ulceration 9
- May be an incidental finding in patients with upper GI bleeding 9
Clinical Course and Management
Natural History
- Symptoms respond to antacid or PPI treatment 3, 4
- Erosions may persist on repeat imaging even after symptom resolution 4
- The condition is most severe and symptomatic between ages 40-60, becoming subclinical in the elderly 5
- In H. pylori-positive patients, antral gastritis worsens over time 8
Treatment Approach
Based on symptom profile 2:
- For epigastric pain: Combination of mucosal protective agent (MPA) plus proton pump inhibitor is most effective
- For postprandial fullness, acid regurgitation, early satiety, or nausea: MPA alone appears more promising
- H. pylori eradication is NOT routinely indicated in erosive gastritis patients 7
Key Clinical Pitfalls
- Do not confuse with acute mucosal erosions - chronic erosive gastritis has distinct pathologic features 9
- Biopsy atypia can be misinterpreted as malignancy - awareness of this entity prevents overdiagnosis of intramucosal carcinoma 3
- Symptoms alone cannot distinguish this from peptic ulcer disease - endoscopy is essential for diagnosis 3
- H. pylori status does not differ significantly between NSAID users and non-users with erosive gastritis 7