gastric antral mucosa with reactive changes

Am J Surg Pathol. [8] The bile reflux may be visible. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. The bile reflux may be visible 20. Call 1860-500-1066 to book an appointment. After a meal, avoid lying down for up to 2 to 3 hours. My doc said I dont have gastritis and nothing is wrong. (See Pathophysiology and Etiology. The accompanying histamine-mediated vascular response leads to edema and hyperemia. 2005 Nov. 22(4):273-83. Furthermore, NSAIDs, being weak organic acids, can freely diffuse into the gastric epithelium. Fallopian tubes & broad ligament Ovary Placenta Pleura & peritoneum Uterus Vulva, vagina & female urethra Head & neck Ear Eye Larynx, hypopharynx & trachea Mandible & maxilla Nasal cavity & nasopharynx Oral cavity & oropharynx Salivary glands Thyroid & parathyroid Hematopathology Bone marrow neoplastic Bone marrow nonneoplastic While most types of gastritis occur throughout the entire gastric mucosa, antral gastritis affects only one region of the stomach. Wolf EM, Plieschnegger W, Schmack B, et al. Infections, physical stress, and even the use of certain medications may be the culprit. [10]. Most people do not experience noticeable effects of intestinal metaplasia. Gastric antral mucosa showing vascularcongestion and increase no of neautrophils and plsma-lymphocyticcell infiltrate vth lympoid aggregates means? What is gastric antral mucosa with reactive Gastropathy? a stomach biopsy. Genta RM. November 9, 2022. Figure 1 shows the changes in percent preoperative weight and food intake up to 24 weeks postoperatively. 2013:393015. Endoscopic evaluation of the effects of aspirin, buffered aspirin, and enteric-coated aspirin on gastric and duodenal mucosa. [5, 6, 7], Reactive gastropathy has also been referred to as chemical gastropathy, reflux gastritis, and type C gastritis. In one study the risk of metaplasia > gastric cancer was 1 IN 39 PATIENTS OVER A 20 YEAR PERIOD. Upper gi, antral mucosa w/ regenerative epithelial changes and vascular congestion. Here are a few easy tips to help prevent gastritis: Gastritis is a common medical condition that can be managed and treated without major complications. The mucosal changes seen in reactive gastropathy are usually most prominent in the antrum and prepyloric region. There is a paucity of both acute and chronic inflammatory cells. Thus, inhibition of COX by NSAIDs reduces prostaglandin synthesis, thereby diminishing mucosal blood flow and decreasing mucus and bicarbonate secretion. MyPathologyReport is independently owned and operated and is not affiliated with any hospital or patient portal. MUC5AC was seen in pyloric glands in 81% of cases, and MUC6 was seen in the upper foveolar epithelium in 14% of cases. Devon has written extensively for Bel Marra Health. This damage prevents the foveolar cells from producing mucus. Alkaline reflux gastritis. The mucosal changes seen in reactive gastropathy are usually most prominent in the antrum and prepyloric region. Considered one of the most common symptoms of antral gastritis, as it affects the process of digestion as well as emptying food into the intestines. [16] but the more proximal oxyntic mucosa may also be affected. "Differential diagnosis of reactive gastropathy.". [QxMD MEDLINE Link]. Types of stomach polyps and their causes and treatments are discussed. Weir, MR.; Espaillat, R. (Jun 2015). It occurs when there's an expansion of unwanted foveolar cells inside the stomach tissues or tissue layer. Sobala GM, King RF, Axon AT, Dixon MF. Vomiting. They generate the mucus inside the stomach that's accountable for shielding the tummy from the gastric acids. Pathogenesis: Gastric lumen o strongly acidic - pH of close to 1 Contribute to digestion May cause potential damage to gastric mucosa o Protective or defense factors Surface mucus - secreted by foveolar cells - Protect the mucosa - Prevent large food to touch directly the mucosa Bicarbonate secretion - by surface epithelial cells . Copyright 2023 Bel Marra Health. It is advisable to eat liquid or mushy food such as soups if experiencing acute gastric pain, as it will be easier on your stomach. Gastric changes due to injury to the mucosa by abnormal luminal contents Alternate/Historical Names Chemical gastropathy Environmental gastritis / gastropathy Reactive gastritis Type C gastritis Some names based on specific causes Bile reflux gastritis NSAID gastritis Diagnostic Criteria Foveolar hyperplasia and expansion When doctors find intestinal metaplasia, it looks like the mucosal lining of your esophagus or stomach has been replaced with intestinal lining. [29] Regular endoscopic surveillance starting 10 to 15 years after surgery is recommended. Bile reflux occurs when bile (a digestive liquid produced by the liver) refluxes or backs up into your stomach and, in certain cases and, into the esophagus (the tube that connects your mouth and stomach). [4], The most common complaint associated with NSAID-induced reactive gastropathy is mild dyspepsia. Gastritis is usually not serious and can be treated through various treatment options. The duodenogastric reflux results in disruption of the protective mucus barrier and direct injury to the gastric mucosa, causing backflow of hydrogen ions and epithelial damage. Messages 32 Location Green Valley, AZ Best answers 0. Ann Intern Med. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTk2Mjg5My1vdmVydmlldw==. The common underlying causes of reactive gastropathy include chronic bile reflux and long-term intake of nonsteroidal anti-inflammatory drugs (NSAIDs) 2. Reactive gastropathy diagnosis is by examination of tissue, e.g. (Dec 2014). Mucosal changes in reactive gastropathy are readily appreciated by comparison with normal gastric mucosa (see the image below). All rights reserved. Reactive (chemical) gastropathy is a gastric mucosal pattern of injury induced by endogenous (bile / pancreatic reflux) or exogenous (chronic use of NSAIDs, acetylsalicylic acid, ethanol or chemotherapeutics) agents . 340(24):1888-99. These features were originally described in biopsy specimens obtained from patients who had undergone gastric surgery and were felt to be specific for bile reflux3. 1983 Nov 12. NSAID gastropathy redirects to here. [QxMD MEDLINE Link]. Reflux gastritis in the intact stomach. The presence of blood in the stool may also be detected. Sharing treatments, cures, causes, and personal experiences are very welcome! Regular endoscopic surveillance starting 10 to 15 years after surgery is recommended. As for the free gifts you receive with your purchase, they are yours to keep as a thank you for giving this natural. Haber MM, Lopez I. Gastric histologic findings in patients with nonsteroidal anti-inflammatory drug-associated gastric ulcer. Poor digestion, stretching, and increment of the stomach takes place during Foveolar Hyperplasia. Eur J Gastroenterol Hepatol. Etymologically, the. specifications following safe manufacturing practices. Another name for this condition is chemical gastropathy. A: Sections from the gastric antrum show portions of antral and oxyntic-type gastric mucosa with edema, vascular congestion and patchy chronic inflammation of the lamina propria. [QxMD MEDLINE Link]. Endoscopy pathology report. By using our website, you consent to our use of cookies. 1985 Aug. 103(2):178-83. Northeast Ohio 216.444.7000 Appointments & Locations [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. May be seen post-Bilroth II (distal gastrectomy). American Society for Investigative Pathology, United States and Canadian Academy of Pathology. Acute gastritis can persist anywhere from 2 to 10 days. enable_page_level_ads: true Histology of the postoperative stomach before and after diversion of bile. Am J Gastroenterol. Re-seal . Arch Pathol Lab Med. lack of large numbers of neutrophils and plasma . The biopsy is usually performed after the patient is sedated and a camera called an endoscope is inserted into the stomach. what does it mean? Chronic alcohol consumption can irritate and damage the stomach lining. 2013. It may range from mild to severe, triggering vomiting in some cases. Does anyone know what it means? Dietary changes and avoiding the irritating causes such as stomach irritating drugs or stressful situations are also helpful in eliminating the symptoms of Chronic, Erosive Gastritis. J Clin Pathol. 2001 Aug. 39(2):133-40. However, if you are experiencing persistent symptoms of gastritis for more than a week, vomiting blood, or have blood in your stool, it is recommended to get yourself checked by your Apollo doctor at the earliest. Arch Pathol Lab Med. Dixon MF, O'Connor HJ, Axon AT, King RF, Johnston D. Reflux gastritis: distinct histopathological entity?. This website also contains material copyrighted by 3rd parties. With the advent of highly effective medical treatment for H pylori infection, there has been a decline in such surgical procedures, paralleled by a reduction in the incidence of stump carcinoma. Take antacids and other medications to lower stomach acid, Combination of antibiotics and an acid-blocking medication to treat gastritis caused by H. pylori infection, B12 vitamin shots (if gastritis is caused by pernicious anemia), Getting rid of irritants in the diet, such as lactose from dairy or gluten from wheat. Rights Reserved. Br Med J (Clin Res Ed). Medscape Education. However, if left untreated, antral gastritis may lead to progressive damage of the stomach lining and potentially create conditions for bacteria to proliferate, resulting in further complication. Vere CC, Cazacu S, Comanescu V, Mogoanta L, Rogoveanu I, Ciurea T. Endoscopical and histological features in bile reflux gastritis. Most stomach polyps are not cancerous, but there are some types that have a higher risk to turn into cancer. Mamoun Younes, MD Professor of Pathology, Director of Gastrointestinal and Liver Pathology Service, University of Texas Health Science Center at Houston, McGovern Medical School [QxMD MEDLINE Link]. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. Another name for this condition is chemical gastropathy. In this study, a score ranging from 0 (normal or absent) to 3 (severe) was assigned to each of the following histologic features: (1) foveolar hyperplasia, (2) edema and smooth muscle fibers in the lamina propria, and (3) vasodilatation and congestion of the lamina propria. The mucosa may be normal or may exhibit erythema, congestion, edema, or erosions. what does this really mean? This page was last edited on 17 June 2016, at 17:47. Mar 16, 2018 #6 Gastric antral vascular ectasia (GAVE), also described as watermelon stomach, is characterized by rows or stripes of ectatic mucosal blood vessels that emanate from the pylorus and extend proximally into the antrum (Fig. Evolving patterns in the diagnosis of reactive gastropathy: data from a prospective Central European multicenter study with proposal of a new histologic scoring system. [QxMD MEDLINE Link]. Special stains for H pylori are negative. 2003 Jan. 15(1):35-40. Abstract Objectives: The gastric mucosal change accompanying gastric antral intestinal metaplasia (IM) in the pediatric population and its clinical implications remain unclear. This is the American ICD-10-CM version of K29.60 - other international versions of ICD-10 K29.60 may differ. . If you are experiencing mild forms of gastritis discomfort, you can try some home remedies: Diet can play in important role in the manifestation of symptoms associated with any type of gastric pain, and following a gastric-specific diet is advisable to help better manage symptoms. Gastroenterol Clin North Am. Loss of appetite, indigestion, weight loss, belching, and stomach bloating are all possible symptoms. The foveolar cells show regenerative changes with mucin depletion, nuclear hyperchromasia, and increased mitoses. It mixes the food with stomach acids. Lauwers GY, Furman J, Michael LE, Balis UJ, Kubilis PS. Arrow points to smooth muscle fibers in superficial lamina propria (original magnification 200). 2013 Aug. 58(8):2266-74. Associated with "mucin depletion" - cytoplasm not clear -- as is usual. We'll go over some of the most common types of gastropathy, frequent symptoms . http://www.cmej.org.za/index.php/cmej/article/view/2316/2190, https://librepathology.org/w/index.php?title=Reactive_gastropathy&oldid=45045, Attribution-NonCommercial-ShareAlike 4.0 International, chemical gastritis, chemical gastropathy, NSAID gastropathy (if due to a NSAID), foveolar hyperplasia - esp. Scores of 10 or higher were found to be highly characteristic of reactive gastropathy (chemical gastropathy). Mod Pathol. Bile gastritis occurring after cholecystectomy. [25]. This question is best answered by your gastroenterologist who had a good look at your tissue and pathology report. This condition can be caused by the following factors: Gastritis, if left untreated, can lead to serious complications like: Anemia: H. pylori can cause stomach ulcers or gastritis that bleed, resulting in a drop in the red blood cell count leading to anemia. Maguilnik, I.; Neumann, WL. [5, 7, 21, 22], The clinical features associated with reactive gastropathy are determined by its underlying cause. 16(4):325-41. Finally . The end-of-study data was captured in the last week of the 1 year after therapy follow up period. AskApollo online Health Information Library is an initiative by Apollo Hospitals for general people, patients, their families and friends who seek useful health information, tips and advice on disease, procedure and certain medications to help you take care of yourself and your loved ones. Gastritis pain due to infection can be remedied by antibiotics targeting the specific causative bacteria. Other causes include alcohol and non-steroidal anti-inflammatory drugs (NSAIDS). [23] Although the findings are not specific, several authors claim that weight loss and a hypochromic microcytic anemia are also associated features. PDF | Sleeve gastrectomy (SG) often induces gastroesophageal reflux, with few and discordant long-term data on the risk of Barrett's esophagus (BE) in. [QxMD MEDLINE Link]. The bile reflux may be visible 20. - Scant or minimal inflammatory cells (white arrow), i.e. Its characteristic feature is presence of coiled and branching antral glands. Often accompanying indigestion, nausea occurs as a result of any sort inflammation that develops within the lining of the stomach. The duodenogastric reflux results in disruption of the protective mucus barrier and direct injury to the gastric mucosa, causing backflow of hydrogen ions and epithelial damage12. It is called squamous mucosa when the top layer is made up of squamous cells. Ritchie WP Jr. Alkaline reflux gastritis. If long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) leads to reactive gastropathy, your doctor may recommend that you stop taking NSAIDs, take a lower dose, or take a different medicine for pain. Taha AS, Nakshabendi I, Lee FD, Sturrock RD, Russell RI. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Never ignore professional medical advice in seeking treatment because of something you have read on the MyPathologyReport site. Gastritis doesn't always cause signs and symptoms. What are reactive changes? Footnote: Antral mucosa exhibiting the features of reactive gastropathy, including corkscrewlike foveolar hyperplasia, a mucin depleted epithelium and bundles of hyperplastic smooth muscle arranged perpendicular to the surface. 1986 May. Quinn CM, Bjarnason I, Price AB. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Moderate reactive gastropathy involving gastric antral mucosa (original magnification 200). 39(5):700-4. Cleveland Clinic is a non-profit academic medical center. Sepulveda AR, Patil M. Practical approach to the pathologic diagnosis of gastritis. Stump carcinoma has been reported in postgastrectomy stomachs. 1991 Feb. 71(1):33-44. In contrast to H pylori gastritis, the surface epithelium lacked Ki67 expression and a downward elongation of the proliferative zone was noted. J Clin Pathol. Stomach Disorders Your stomach is an organ between your esophagus and small intestine. Gastritis can develop quickly (acute gastritis) or gradually over time (chronic gastritis). Mod Pathol. It can lead to ulcers and may also increase the risk of developing stomach cancer. To date, no specific genetic predisposing factors for the development of reactive gastropathy have been identified. 287(6403):1410-2. The oxyntic mucosa of the gastric body and fundus has glands with parietal cells that secrete acid, and chief cells that secrete digestive enzymes. The results probably reflect regeneration process from an. Hepatologist & Transplant Hepatologist, Sign up for our free Health Library Daily Newsletter, What Is Antral Gastritis? Had endoscopy done extremely mild im found. El-Zimaity HM, Genta RM, Graham DY. Antral Mucosa with mild reactive changes? 46(4):269-74. Once there, food contents may begin fermenting for extended periods of time, leading to bloating and flatulence. [3] and occasionally after cholecystectomy and ampullary sphincterotomy. Mamoun Younes, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society of Clinical Oncology, College of American Pathologists, United States and Canadian Academy of PathologyDisclosure: Nothing to disclose. The densities of inflammatory cells and reactive atypia were scored at squamous, cardiac and oxyntocardiac mucosa of SCJ, antrum and body. 2008 Oct. 132(10):1586-93. what are my odds of getting colon or gastric cancer. As a result of the neutral pH within the surface epithelial cells, the NSAID compound dissociates into its ionized form, contributing to direct cell injury 14. Make certain that the tissue is positioned to have maximum contact with the reactive pad. * Makes catalase, oxidase & urease * Urease HELPS it survive in stomach by neutralizing stomach acid. Doctors may also recommend taking a proton pump inhibitor (PPI) and prostaglandin analogues along with NSAIDs to prevent or treat reactive gastropathy and its possible complications. 2003 Jan. 15(1):35-40. Pernicious anemia: Autoimmune gastritis might impair vitamin B12 absorption. The diagnosis of reactive gastritis is made after a pathologist examines a tissue sample from the inside of the stomach under the microscope. 137(4):527-31. Reactive gastropathy is a condition that develops when substances such as non-steroidal anti-inflammatory drugs (NSAIDs), alcohol, or bile damage the cells that cover the inside of the stomach. Reactive gastropathy refers to a group of endoscopic and histologic findings caused by chemical injury to the gastric mucosa1. Discomfort. What Is Intermittent Fasting? N Engl J Med. Mucin expression in reactive gastropathy: an immunohistochemical analysis. H. pylori bacteria are the most common cause of persistent gastritis and peptic ulcer disease (stomach ulcers). A number of things, including chronic reflux (regurgitation) of stomach contents up into the esophagus, trauma from taking medicines, and infections can injure the squamous lining of the esophagus. [14] However, most of these COX-2 inhibitors have been withdrawn from the market or have had their indications drastically limited in view of their potential serious cardiovascular side effects. Surgery. Gas. ; Plieschnegger, W.; Schmack, B.; Bordel, H.; Hfler, B.; Eherer, A.; Schulz, T.; Vieth, M. et al. Moderate reactive gastropathy. Nausea. Chronic gastritis can continue anywhere from weeks to years, if not treated. Home Colon And Digestive What causes antral gastritis and how to treat it? [QxMD MEDLINE Link]. This region is responsible for releasing the contents of the stomach into the small intestine. Reactive gastropathy is characterized, histologically, by 21: Definition: The antral mucosa (Synonym: pyloric mucosa) is the mucosa found in the gastric antrum. a weakened immune system. International Workshop on the Histopathology of Gastritis, Houston 1994. N Engl J Med. How Long Does Our Immunity Last? [24]. Cytoskeletal and kinetic epithelial differences between NSAID gastropathy and Helicobacter pylori gastritis: an immunohistochemical determination. Are there neutrophils in the mucosa? Abha Goyal, MD Associate Staff Pathologist, Cleveland Clinic The following are common treatments for managing and treating antral gastritis: Antral gastritis, or gastritis in general, can be prevented by following healthy lifestyle habits and a balanced diet. Thus, inhibition of COX by NSAIDs reduces prostaglandin synthesis, thereby diminishing mucosal blood flow and decreasing mucus and bicarbonate secretion. One may also feel a burning sensation in the upper abdomen. [Full Text]. Diagram of the alkaline mucous layer in the stomach with mucosal defense mechanisms. For these, please consult a doctor (virtually or in person). El-Zimaity HM, Genta RM, Graham DY. [2, 3, 4] It has since become apparent, however, that the constellation of histologic features seen in reactive gastropathy is a nonspecific response to chemical injury of the gastric mucosa. [13]. All Rights Reserved. [Full Text]. "Clinical perspectives on the rationale for potassium supplementation.". The following symptoms may be experienced: Indigestion. The updated Sydney System. In fact, the condition is not typically associated with any symptoms. 303(3):136-8. tortuosity of glands in the "neck" region (S shaped glands), smooth muscle hyperplasia, scant inflammatory cells, +/-edema, +/-erosions, Sodium polystyrene sulfonate (Kayexalate). The objective of this health library is to engage our community and offer relevant, trusted and easy to understand health & wellness information that can be accessed anywhere, anytime, on any device for FREE. benign gastric antral mucosa with mild chronoc inactive gastitis focal intestinal metaplasia present? Bile reflux usually occurs in patients who have undergone a Billroth 2 partial gastrectomy; it is also recognized to occur in intact stomachs in individuals with alcohol abuse, cigarette smoking, chronic respiratory disease, or duodenal ulcer, and even in healthy subjects 11. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. Severe reactive gastropathy with mucosal erosion of gastric antral mucosa (original magnification 200). Bile reflux is thought to play a key role in the development of dysplasia and carcinoma in the gastric remnant22. [Full Text]. Reactive gastropathy is characterized, histologically, by 21: If long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) leads to reactive gastropathy, your doctor may recommend that you stop taking NSAIDs, take a lower dose, or take a different medicine for pain. The presentation of gastritisinflammation of the stomach liningcan be due to various causes. You have 30 days to try one bottle of the product. Johannesson KA, Hammar E, Stael von Holstein C. Mucosal changes in the gastric remnant: long-term effects of bile reflux diversion and Helicobacter pylori infection. The most common benign cause of mucosal ulcerations is peptic ulcer disease. Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. Schoenfeld P, Kimmey MB, Scheiman J, Bjorkman D, Laine L. Review article: nonsteroidal anti-inflammatory drug-associated gastrointestinal complications--guidelines for prevention and treatment. By working to inform readers of the options available to them, he hopes to improve their health and quality of life. 39(5):524-30. Genta RM. Chronic consumption of these drugs, however, can lead to the development of erosions and ulcers, increasing the risk for complications such as obstruction, perforation, and bleeding. Mine said something similar. Semin Diagn Pathol 2005; 22: 27383. Differential diagnosis of reactive gastropathy. International Workshop on the Histopathology of Gastritis, Houston 1994. This finding, along with its distinctive endoscopic appearance ("watermelon stomach"), aids in the differentiation of GAVE from other similar-appearing entities. Dr. Susan Madonna answered Family Medicine 23 years experience Gastritis: This is the mucosal lining of a section of the stomach called the gastric antrum. Gastritis in patients on non-steroidal anti-inflammatory drugs. This was the only thing on my colonoscopy/endoscopy report that I don't understand. can it come back with stress? 1993 Oct. 23(4):341-8. [13], Although it is known that NSAIDs that selectively inhibit COX-2 cause significantly fewer GI complications than nonselective COX inhibitors do, it is still unclear whether administration of selective inhibitors results in less severe reactive gastropathy (chemical gastropathy). Mod Pathol. 16(4):325-41. using current production and quality control standards. Differential diagnosis of reactive gastropathy. These gastric mucosal protection and ulcer healing effects are associated with antioxidant effects and the augmentation of prostaglandin E2 and suggest that P. cuspidatum might be a promising . Book An Appointment.no-styles{background-color:transparent !important;}. https://www.askapollo.com/doctors/medical-gastroenterologist/hyderabad/dr-naveen-polavarapu. Billroth II. after finishing therapy. May be seen in the context of a previous resection/surgical reconstruction, e.g. Pathologic duodenogastric reflux associated with persistence of symptoms after cholecystectomy. Squamous cells are flat cells that look similar to fish scales when viewed under the microscope. Gastric biopsy result: antral mucosa revealing mild to moderate chronic inflamation with associated extensive intestinal metaplesia. Watt PC, Sloan JM, Spencer A, Kennedy TL. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. A feeling of fullness in your upper abdomen after eating. There is a range of risk factors that may lead to. 43(4):303-6. What is the antrum in the body? The inner lining of the esophagus is known as the mucosa. It consists of simple columnar epithelium, lamina propria, and the . The gastric mucosa becomes thinner as the normal cells are destroyed. 1992 Feb. 45(2):135-9. Reactive gastropathy is the second most common pathologic diagnosis rendered on gastric biopsies, after Helicobacter pylori gastritis (H pylori -associated active gastritis is discussed in a separate pathology article). Share cases and questions with Physicians on Medscape consult. This low-acid fruit can benefit those who suffer from acid reflux by soothing an inflamed esophagus lining and therefore alleviating discomfort. The most common cause of chronic inactive gastritis is an infection of the stomach with a bacteria called Helicobacter pylori. [2] The accompanying histamine-mediated vascular response leads to edema and hyperemia. The following microscopic features are typically seen in reactive gastropathy: With the right information, patients can make the best decisions about their care. It is typically acute, manifesting with bleeding, but may be subacute or chronic with few or no symptoms. Numerous clinical studies have demonstrated elevated levels of depressive symptoms among selected samples of patients with gastritis [1,2,3,4,5].In patients with Helicobacter pylori-induced gastritis, levels of interleukin (IL)-8 and tumour necrosis factor- are increased in the gastric mucosa and the bacterial infection indirectly activates nuclear factor kappa B (NF- B) [6,7,8].