Pathology Report Interpretation: Mild Inactive Chronic Gastritis, H. pylori Negative
This pathology report indicates benign findings with mild chronic gastritis in the stomach antrum that is currently inactive (not actively inflamed) and negative for H. pylori infection, while the small bowel shows normal architecture without evidence of celiac disease, Whipple's disease, or parasitic infection.
Small Bowel Findings
The duodenal/small bowel biopsy shows:
- Normal mucosal architecture with intact villi and appropriate plasma cell populations 1
- No evidence of celiac disease (no villous atrophy or increased intraepithelial lymphocytes) 1
- No Whipple's disease (no PAS-positive macrophages) 1
- No Giardia parasites identified 1
These findings effectively rule out malabsorptive disorders as a cause of symptoms in this patient 1.
Gastric Antrum Findings
The stomach biopsy reveals:
- Mild inactive chronic gastritis: This indicates past or ongoing low-grade inflammation without current active inflammatory cells (neutrophils) 1, 2
- H. pylori negative: No bacteria identified on histologic examination 1
- Gastric antral mucosa: The location suggests non-atrophic gastritis pattern 1
Clinical Significance
The H. pylori-negative status is the most important finding, as it indicates:
- No need for H. pylori eradication therapy since the organism is absent 1, 3
- Lower risk for peptic ulcer disease compared to H. pylori-positive patients 2
- Substantially lower gastric cancer risk compared to H. pylori-associated atrophic gastritis 1, 2
The "mild inactive" designation means:
- Chronic inflammation is present but minimal in severity 1
- No active acute inflammation (absence of neutrophils indicates "inactive" status) 4
- No atrophy or intestinal metaplasia mentioned, which would increase cancer risk 1
Differential Diagnosis for H. pylori-Negative Chronic Gastritis
Possible causes in elderly patients include:
- Autoimmune gastritis (though this typically affects corpus, not antrum) 1, 2
- NSAID use or other medication-related injury 1
- Bile reflux gastritis 1
- Age-related changes in gastric mucosa 5
- Previous H. pylori infection that spontaneously cleared (rare in adults) 5, 4
Recommended Management
No specific treatment is required for mild inactive chronic gastritis that is H. pylori-negative 1, 3. However:
- If the patient has dyspeptic symptoms, consider empiric acid suppression with proton pump inhibitors for symptom management 3
- Avoid NSAIDs if possible, as they can exacerbate gastritis 1
- No routine surveillance endoscopy is indicated for mild non-atrophic gastritis without intestinal metaplasia 1
- Recheck for H. pylori only if symptoms persist or worsen, as false-negative histology can occur in patients on acid suppression 1, 3
Important Caveats
The absence of H. pylori on histology does not always mean true absence, particularly if:
- The patient was taking proton pump inhibitors, antibiotics, or bismuth within 2 weeks before biopsy 3
- Only antral biopsies were obtained (H. pylori may be present only in corpus in patients on acid suppression) 1
- Sampling error occurred 1
If clinical suspicion for H. pylori remains high despite negative histology (e.g., active peptic ulcer disease), consider non-invasive testing with urea breath test or stool antigen test at least 2 weeks after stopping acid suppression 3.
The normal small bowel biopsy effectively excludes celiac disease as a cause of symptoms, which is reassuring given the overlap in presentation between celiac disease and functional dyspepsia 1.