What does a biopsy showing mild inactive chronic gastritis without H. pylori infection in the stomach antrum and no abnormalities in the small bowel mucosa mean?

Understanding Your Biopsy Results

Your biopsies show mild, inactive chronic gastritis in the stomach antrum without H. pylori infection, and normal small bowel tissue—findings that indicate low-grade, non-progressive inflammation that typically requires no immediate treatment but warrants investigation into the underlying cause. 1

What the Stomach (Antrum) Findings Mean

Mild Inactive Chronic Gastritis

• "Chronic gastritis" means there is long-standing inflammation in the stomach lining, evidenced by increased inflammatory cells (lymphocytes and plasma cells) in the tissue 2, 3
• "Inactive" indicates there is no active, ongoing tissue damage—no neutrophils destroying the lining, no erosions, and no ulcers 3
• "Mild" means the degree of inflammation is minimal and not causing significant architectural changes to the stomach lining 4

H. Pylori Negative Status

• The absence of H. pylori is clinically significant because it rules out the most common cause of chronic gastritis 1
• This finding suggests your gastritis may be due to:
  • Previous H. pylori infection that was either spontaneously cleared or successfully treated (minimal chronic inactive gastritis is significantly associated with prior H. pylori infection in 43.8-50% of cases) 4
  • Medication use (NSAIDs, aspirin, or other drugs causing gastropathy) 2, 3
  • Autoimmune gastritis (though this typically affects the stomach body more than antrum) 1
  • Idiopathic causes when no clear etiology is identified 2

What the Small Bowel Findings Mean

Normal Duodenal Mucosa

• Presence of villi and plasma cells is normal anatomy—villi are the finger-like projections that absorb nutrients, and plasma cells are part of the normal immune surveillance 1
• No diagnostic abnormality means the architecture is preserved with no villous atrophy, no increased intraepithelial lymphocytes, and no crypt hyperplasia 1

Negative for Specific Diseases

• No celiac disease: The normal villous architecture rules out celiac disease, which would show villous blunting or atrophy 1
• No Giardia: Excludes this parasitic infection that can cause malabsorption 5
• No "Wibbles disease" (likely Whipple's disease): Rules out this rare bacterial infection that causes malabsorption 5

Clinical Significance and Next Steps

Risk Assessment

• Your gastritis pattern carries extremely low risk for:
  • Peptic ulcer disease (inactive gastritis without H. pylori makes ulcers unlikely) 3
  • Gastric cancer (mild, antrum-limited gastritis without atrophy or intestinal metaplasia is low-risk) 1
  • Malabsorption (normal small bowel architecture) 1

Recommended Evaluation

• Review medication history for NSAIDs, aspirin, bisphosphonates, or antibiotics that may cause gastritis 2, 3
• Consider H. pylori serology (ELISA or complement binding reaction) to determine if this represents post-eradication gastritis, as 50% of minimal chronic inactive gastritis cases have positive serology indicating prior infection 4
• Assess for autoimmune markers (parietal cell antibodies, intrinsic factor antibodies) if corpus biopsies were also obtained and showed atrophy, though your antrum-only findings make autoimmune gastritis less likely 1
• Check vitamin B12 levels if there are any concerns about absorption or if autoimmune gastritis is suspected 1

Management Approach

• No immediate treatment is required for mild inactive chronic gastritis without H. pylori 1
• If medication-related: Discontinue or reduce offending agents if clinically feasible 2, 3
• If symptoms persist: Consider empiric acid suppression with proton pump inhibitors for symptom management, though this does not address the underlying inflammation 2
• Surveillance endoscopy is not indicated for mild, non-atrophic gastritis limited to the antrum 1

Common Pitfalls to Avoid

• Do not assume this gastritis explains all upper GI symptoms—the correlation between endoscopic/histologic gastritis and clinical symptoms is poor 6
• Do not pursue aggressive treatment in the absence of H. pylori or significant pathology 1
• Do not overlook medication history—NSAIDs and aspirin are strongly correlated with these findings even when patients don't report "stomach problems" 6, 2
• Recognize that lymphoid aggregates (collections of immune cells) in the biopsy, if present, are another indicator of previous H. pylori infection even when the organism is no longer detectable 4