Skip to main content

A reappraisal of the nature and significance of chronic atrophic gastritis

The American Journal of Digestive Diseases volume 18, pages 426–440 (1973)Cite this article

Summary

It is proposed that two types of atrophic gastritis, Type A and B, can be distinguished in man on the basis of the distribution of the disease in the stomach and results of autoimmune serologic tests. In Type A gastritis the test for parietal cell antibody (PCA) is positive and serum gastrin levels are high, reflecting an intact antral mucosa demonstrable also by biopsy. Corpus changes are diffuse and gastric secretion of acid severely impaired. In Type B gastritis the test for PCA is negative and serum gastrin levels are low, reflecting antral damage. Corpus changes tend to be focal and gastric secretion of acid is moderately to severely impaired. Chronic gastritis occurs frequently (prevalence, 28%) in Caucasian adult populations, Type B being four times more frequent than Type A. Several endocrine diseases and other organ-specific autoimmune reactions are strongly linked to Type A gastritis; pernicious anemia evolves almost exclusively from this type. Gastrointestinal symptoms, gastric hemorrhage and gastric ulcer are prominent sequelae of Type B gastritis. Iron deficiency and gastric carcinoma can develop from both forms of gastritis, but Type B is the more important precursor of carcinoma. Autoimmunity is believed to be of primary importance in Type A gastritis and is probably genetically determined. Environmental factors, including several mucosal “irritants” may determine the occurrence of Type B gastritis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Fenwick S: On atrophy of the stomach. Lancet 2:78, 1870

    Google Scholar 

  2. Faber K, Bloch CE: Über die pathologischer Verunderungen am Digestions Tractus bei der perniciosen Anämie und über die Sogenannte. Dermat Z Klin Med 40:98, 1900

    Google Scholar 

  3. Magnus HA: Observations on the presence of intestinal epithelium in the gastric mucosa. J Pathol Bact 44:389, 1937

    Google Scholar 

  4. Kenamore B: Biopsy forceps for flexible gastroscope. Am J Dig Dis 7:539, 1940

    Google Scholar 

  5. Benedict EB: An operating gastroscope. Gastroenterology 2:281, 1948

    Google Scholar 

  6. Wood IJ, Doig RK, Motteram R, et al.: Gastric biopsy: report on fifty-five biopsies using a new flexible gastric biopsy tube. Lancet 1:18, 1949

    Google Scholar 

  7. Wood IJ, Taft LI: Diffuse Lesions of the Stomach. London, Arnold, 1958

    Google Scholar 

  8. Coghill NF: The significance of gastritis. Postgrad Med J 36:733, 1960

    Google Scholar 

  9. Witts LJ. The Stomach and Anaemia. London, Athlone Press, 1966

    Google Scholar 

  10. Taylor KB, Fisher JM: Gastritis, Progress in Gastroenterology, Vol. 1. Edited by GB Jerzy Glass. New York. Grune & Stratton Inc, 1968

    Google Scholar 

  11. Strickland RG, Korman MG, Hansky J: Gastrin, age and the gastric mucosa. Aust NZ J Med (In press)

  12. McGuigan JE: Immunochemical studies with synthetic human gastrin. Gastroenterology 54:1005, 1968

    Google Scholar 

  13. Irvine WJ, Davies SH, Delamore IW, et al: Immunological relationship between pernicious anaemia and thyroid disease. Br Med J 2:454, 1962

    Google Scholar 

  14. Taylor KB, Roitt IM, Doniach D, et al: Autoimmune phenomena in pernicious anaemia: gastric antibodies. Br Med J 2:1347, 1962

    Google Scholar 

  15. Taylor KB: Inhibition of intrinsic factor by pernicious anaemia sera. Lancet 2:106, 1959

    Google Scholar 

  16. Coghill NF, Doniach D, Roitt IM, et al: Autoantibodies in simple atrophic gastritis. Gut 6:48, 1965

    Google Scholar 

  17. te Velde K, Hoedemaeker PI, Anders GJPA, et al A comparative morphological and functional study of gastritis with and without autoantibodies. Gastroenterology 51:138, 1966

    Google Scholar 

  18. Fisher JM, Mackay IR, Taylor KB, et al: An immunological study of categories of gastritis. Lancet 1:176, 1967

    Google Scholar 

  19. Magnus HA, Ungley CC: The gastric lesion in pernicious anaemia. Lancet 1:420, 1938

    Google Scholar 

  20. Meulengracht E: Histologic investigation into the pyloric gland organ in pernicious anemia. Am J Med Sci 197:201, 1939

    Google Scholar 

  21. Cox AJ: The stomach in pernicious anemia. Am J Pathol 19:491, 1943

    Google Scholar 

  22. McGuigan JE, Trudeau WL: Serum gastrin concentrations in pernicious anemia. N Engl J Med 282:358, 1970

    Google Scholar 

  23. Korman MG, Strickland RG, Hansky J: Serum gastrin in chronic gastritis. Br Med J 2:16, 1971

    Google Scholar 

  24. Strickland RG, Bhathal PS, Korman MG, et al: Serum gastrin and the antral mucosa in atrophic gastritis. Br Med J 4:451, 1971

    Google Scholar 

  25. Korman MG, Strickland RG, Hansky J: The functional “G” cell mass in atrophic gastritis. Gut 13:349, 1972

    Google Scholar 

  26. Creutzfeldt W, Arnold R, Creutzfeldt C et al: Gastrin and G-cells in the antral mucosa of patients with pernicious anaemia, acromegaly and hyperparathyroidism and in a Zollinger-Ellison tumour of the pancreas. Eur J Clin Invest 1:464, 1971

    Google Scholar 

  27. Siurala M, Isokoski M, Varis K, et al: Prevalence of gastritis in a rural population: bioptic study of subjects selected at random. Scand J Gastroenterol 3:211, 1968

    Google Scholar 

  28. Isokoski M, Krohn K, Varis K, et al: Parietal cell and intrinsic factor antibodies in a Finnish rural population sample. Scand J Gastroenterol 4:521, 1969

    Google Scholar 

  29. Wright R, Whitehead R, Wangel AG, et al: Autoantibodies and microscopic appearance of gastric mucosa. Lancet 1:618, 1966

    Google Scholar 

  30. Castle WB, Townsend WC: Observations on the etiologic relationship of achylia gastrica to pernicious anemia: III. The nature of the reaction between normal gastric juice and beef muscle leading to clinical improvement and increased blood formation similar to the effect of liver feeding. Am J Med Sci 180:305, 1930

    Google Scholar 

  31. Gullberg R: Sensitive test for antibody Type 1 to intrinsic factor. Clin Exp Immunol 9:833, 1971

    Google Scholar 

  32. Rose MS, Chanarin I, Doniach D, et al: Intrinsic factor antibodies in absence of pernicious anaemia. Lancet 2:9, 1970

    Google Scholar 

  33. Twomey JJ, Jordan PH, Jarrold T, et al: The syndrome of immunoglobulin deficiency and pernicious anemia. Am J Med 47:340, 1969

    Google Scholar 

  34. Cowling DC, Strickland RG, Ungar B, et al: Pernicious-anaemia-like syndrome with immunoglobulin deficiency. (In press)

  35. Tudhope GR, Wilson GM: Anaemia in hypothyroidism. Q J Med 29:513, 1960

    Google Scholar 

  36. McNicol GP: Thyrotoxicosis associated with pernicious anemia. Am J Med Sci 241:336, 1961

    Google Scholar 

  37. Arapakis G, Bock OAA, Williams DL, et al: Diabetes mellitus and pernicious anaemia. Br Med J 1:159, 1963

    Google Scholar 

  38. Ungar B, Stocks AE, Martin FIR, et al: Intrinsic factor antibody, parietal cell antibody and latent pernicious anaemia in diabetes mellitus. Lancet 2:415, 1968

    Google Scholar 

  39. Irvine WJ, Clarke BF, Scarth L, et al: Thyroid and gastric autoimmunity in patients with diabetes mellitus. Lancet 2:163, 1970

    Google Scholar 

  40. Irvine WJ, Stewart AG, Scarth L: A clinical and immunological study of adrenocortical insufficiency (Addison's disease). Clin Exp Immunol 2:31, 1967

    Google Scholar 

  41. Blizzard RM, Chee D, Davis W: The incidence of parathyroid and other antibodies in the sera of patients with idiopathic hypoparathyroidism. Clin Exp Immunol 1:119, 1966

    Google Scholar 

  42. Howitz J, Schwartz M: Vitiligo, achlorhydria and pernicious anaemia. Lancet 1:1331, 1971

    Google Scholar 

  43. Edwards FC, Coghill NF: Clinical manifestations in patients with chronic atrophic gastritis, gastric ulcer and duodenal ulcer. Q J Med 37:337, 1968

    Google Scholar 

  44. Katz D, Douvres P, Weisberg H, et al: Early endoscopic diagnosis of acute upper gastrointestinal hemorrhage: demonstration of relatively high incidence of erosions as a source of bleeding. JAMA 188:405, 1964

    Google Scholar 

  45. Langman MJS, Hansky J, Drury RAB, et al: The gastric mucosa in radiologically negative acute gastrointestinal bleeding. Gut 5:550, 1964

    Google Scholar 

  46. Menguy R, Gadacz T, Zajtchuk R: The surgical management of acute gastric mucosal bleeding. Arch Surg 99:198, 1969

    Google Scholar 

  47. Winawer SJ, Bejar J, McCray RS, et al: Hemorrhagic gastritis: importance of associated chronic gastritis. Arch Intern Med 127:129, 1971

    Google Scholar 

  48. Chapman MA, Werther JL, Janowitz HD: Response of the normal and pathological human gastric mucosa to an instilled acid load. Gastroenterology 55:344, 1968

    Google Scholar 

  49. Davenport HW: Damage to the gastric mucosa: effects of salicylates and stimulation. Gastroenterology 49:189, 1965

    Google Scholar 

  50. Hebbel R: Chronic gastritis: its relation to gastric and duodenal ulcer and to gastric carcinoma. Am J Pathol 19:43, 1943

    Google Scholar 

  51. Magnus HA: The pathology of simple gastritis. J Pathol Bact 58:431, 1946

    Google Scholar 

  52. Du Plessis DJ: Some aspects of the pathogenesis and surgical management of peptic ulcers. S Afr Med J 34:101, 1960

    Google Scholar 

  53. Du Plessis DJ: Pathogenesis of gastric ulceration. Lancet 1:974, 1965

    Google Scholar 

  54. Ball PAJ, James AH: The histological background to gastric ulcer. Lancet 1:1365, 1961

    Google Scholar 

  55. Gear MWL, Truelove SC, Whitehead R: Gastric ulcer and gastritis. Gut 12:639, 1971

    Google Scholar 

  56. Doniach D, Roitt IM: An evaluation of gastric and thyroid autoimmunity in relation to haematologic disorders. Seminars Haemat 1:313, 1964

    Google Scholar 

  57. Kravetz RE, Van Noorden S, Spiro HM: Parietal cell antibodies in patients with duodenal ulcer and gastric cancer. Lancet 1:235, 1967

    Google Scholar 

  58. Emos S, Borg I, Fyro B: Antral and duodenal gastrin activity in non-ulcer and ulcer patients. Scand J Gastroenterol 6:39, 1971

    Google Scholar 

  59. Trudeau WL, McGuigan JE: Serum gastrin levels in patients with peptic ulcer disease. Gastroenterology 59:6, 1970

    Google Scholar 

  60. Korman MG, Soveny C, Hansky J: Gastrin studies in gastric ulcer. Gut 13:166, 1972

    Google Scholar 

  61. Ritchie WP, Delaney JP: The susceptibility of experimental atrophic gastritis to ulceration. Gastroenterology 60:554, 1971

    Google Scholar 

  62. Dagg JH, Goldberg A, Gibbs WN, et al: Detection of latent pernicious anaemia in iron deficiency anaemia. Br Med J 2:619, 1966

    Google Scholar 

  63. Lees F, Rosenthal FD. Gastric mucosal lesions before and after treatment in iron deficiency anaemia. Q J Med 27:19, 1958

    Google Scholar 

  64. Mackay IR, Hislop IG: Chronic gastritis and gastric ulcer. Gut 7:228, 1966

    Google Scholar 

  65. Croft DN, Pollock DJ, Coghill NF: Cell loss from human gastric mucosa measured by the estimation of desoxyribonucleic acid (DNA) in gastric washings. Gut 7:333, 1966

    Google Scholar 

  66. Sutton DR, Baird IMcL, Stewart JS, et al: “Free” iron loss in atrophic gastritis, postgastrectomy states and adult coeliac disease. Lancet 2:387, 1970

    Google Scholar 

  67. Jacobs A, Owen GM: Effect of gastric juice on iron absorption in patients with gastric atrophy. Gut 10:488, 1969

    Google Scholar 

  68. Murray MJ, Stein N: Gastric mucosal antibodies and iron absorption. Proc Soc Exp Biol Med 131:565, 1969

    Google Scholar 

  69. Mosbech J, Videbaek A: Mortality in and risk of gastric carcinoma among patients with pernicious anaemia. Br Med J 2:390, 1950

    Google Scholar 

  70. Imai T, Kubo T, Watanabe H: Chronic gastritis in Japanese with reference to high incidence of gastric carcinoma. J Nat Cancer Inst 47:179, 1971

    Google Scholar 

  71. Pastore JO, Kato H, Belsky JL: Serum pepsin and tubeless gastric analysis as predictors of stomach cancer: a 10-year follow-up study, Hiroshima. N Engl J Med 286:279, 1972

    Google Scholar 

  72. Siurala M, Varis K, Wiljasalo M: Studies of patients with atrophic gastritis: a 10–15 year follow-up. Scand J Gastroenterol 1:40, 1966

    Google Scholar 

  73. Walker IR, Strickland RG, Ungar B, et al: Simple atrophic gastritis and gastric carcinoma. Gut 12:906, 1971

    Google Scholar 

  74. Ungar B, Strickland RG, Francis C: The prevalence and significance of circulating antibodies to gastric intrinsic factor and parietal cells in gastric carcinoma. Gut 12:903, 1971

    Google Scholar 

  75. Isokoski M: Screening for atrophic gastritis: comparison of the results of Azure-A test and uropepsin determination with gastric biopsy in a rural population. Scand J Gastroenterol 4:425, 1969

    Google Scholar 

  76. Wall AJ, Ungar B, Baird CW, et al: Malnutrition after partial gastrectomy: influence of site of ulcer and type of anastomosis and role of gastritis. Am J Dig Dis 12:1077, 1967

    Google Scholar 

  77. Seibi K, Prolla JC, Kirsner JB: Late gastric carcinoma developing after surgery for benign conditions. Am J Dig Dis 15:905, 1970

    Google Scholar 

  78. Stalsberg H, Taksdal S: Stomach cancer following gastric surgery for benign conditions. Lancet 2:1175, 1971

    Google Scholar 

  79. Strickland RG, Baur S, Ashworth LAE, et al: A correlative study of immunological phenomena in pernicious anaemia. Clin Exp Immunol 8:25, 1971

    Google Scholar 

  80. Baur S, Fisher JM, Strickland RG, et al: Autoantibody-containing cells in the gastric mucosa in pernicious anaemia. Lancet 2:887, 1968

    Google Scholar 

  81. Rose MS, Chanarin I: Dissociation of intrinsic factor from its antibody: application to study of pernicious anaemia gastric juice specimens. Br Med J 1:468, 1969

    Google Scholar 

  82. Goldberg LS, Bluestone R: Hidden gastric autoantibodies to intrinsic factor in pernicious anemia. J Lab Clin Med 75:449, 1970

    Google Scholar 

  83. Jacob E, Glass GBJ. The participation of complement in the parietal cell antigen-antibody reaction in pernicious anaemia and atrophic gastritis. Clin Exp Immunol 5:141, 1969

    Google Scholar 

  84. Jacob E, Glass GBJ: Localization of intrinsic factor and complement fixing intrinsic factorintrinsic factor antibody complex in parietal cell of man. Clin Exp Immunol 8:517, 1971

    Google Scholar 

  85. Ardeman S, Chanarin I: Steroids and Addisonian pernicious anemia. N Engl J Med 273:1352, 1965

    Google Scholar 

  86. Jeffries GH, Todd JE, Sleisenger MH: The effect of prednisolone on gastric mucosal histology, gastric secretion and vitamin B12 absorption in patients with pernicious anemia. J Clin Invest 45:803, 1966

    Google Scholar 

  87. Rodbro P, Dige-Petersen H, Schwartz M, et al: Effect of steroids on gastric mucosal structure and function in pernicious anaemia. Acta Med Scand 181:445, 1967

    Google Scholar 

  88. Wall AJ, Whittingham S, Mackay IR, et al: Prednisolone and gastric atrophy. Clin Exp Immunol 3:359, 1968

    Google Scholar 

  89. Krohn K: Experimental gastritis in the dog: I. Production of atrophic gastritis and antibodies to parietal cells. Ann Med Exp Biol Fenn 46:249, 1968

    Google Scholar 

  90. Andrada JA, Rose NR, Andrada EC: Experimental autoimmune gastritis in the Rhesus monkey. Clin Exp Immunol 4:293, 1969

    Google Scholar 

  91. Tai C, McGuigan JE: Immunologic studies in pernicious anemia. Blood 34:63, 1969

    Google Scholar 

  92. Fixa B, Thiele HG: Delayed hypersensitivity to intrinsic factor in pernicious anaemia: a preliminary report. Med Exp 19:231, 1969

    Google Scholar 

  93. Tanaka N, Glass GBJ: Effect of prolonged administration of parietal cell antibodies from patients with atrophic gastritis and pernicious anemia on the parietal cell mass and hydrochloric acid output in rats. Gastroenterology 58:482, 1970

    Google Scholar 

  94. Inada M, Glass GBJ: Effects of prolonged administration of intrinsic factor antibodies on gastric morphology and secretion in rats. Fed Proc 31:299, 1972

    Google Scholar 

  95. Wangle AG, Callender ST, Spray GH, et al: A family study of pernicious anaemia: I. Autoantibodies, achlorhydria, serum pepsinogen and vitamin B12. Br J Haemat 14:161, 1968

    Google Scholar 

  96. Wangel AG, Callender ST, Spray GH, et al: A family study of pernicious anaemia: II. Intrinsic factor secretion, vitamin B12 absorption and genetic aspects of gastric autoimmunity. Br J Haemat 14:183, 1968

    Google Scholar 

  97. Whittingham S, Ungar B, Mackay IR, et al: The genetic factor in pernicious anaemia: a family study in patients with gastritis. Lancet 1:951, 1969

    Google Scholar 

  98. Balcerzak SP, Westerman MP, Heinle EW: Discordant occurrence of pernicious anemia in identical twins. Blood 32:701, 1968

    Google Scholar 

  99. Hooper B, Whittingham S, Mathews JD, et al: Autoimmunity in a rural community. Clin Exp Immunol 12:79, 1972

    Google Scholar 

  100. Martin F, McLeod IB, Sircus W: Effects of antrectomy on the fundic mucosa of the rat. Gastroenterology 59:437, 1970

    Google Scholar 

  101. Edwards FC, Coghill NF: Aetiological factors in chronic atrophic gastritis. Br Med J 2:1409, 1966

    Google Scholar 

  102. Dinoso VP, Chey WY, Braverman SP, et al: Gastric secretion and gastric mucosal morphology in chronic alcoholics. Arch Intern Med 130:715, 1972

    Google Scholar 

  103. Chapman BL, Duggan JM: Aspirin and uncomplicated peptic ulcer. Gut 10:443, 1969

    Google Scholar 

  104. Cheng J, Ritchie WP, Delaney JP: Atrophic gastritis: an experimental model. Fed Proc 28:513, 1969

    Google Scholar 

  105. Menguy R, Max MH: Influence of bile on the canine gastric-antral mucosa. Am J Surg 119:177, 1970

    Google Scholar 

  106. Flint FJ, Grech P: Pyloric regurgitation and gastric ulcer. Gut 11:735, 1970

    Google Scholar 

  107. Capper WM: Dyspepsia. Hosp Med 1:1053, 1967

    Google Scholar 

  108. Rhodes J, Barnado DE, Phillips SF, et al: Increased reflux of bile into the stomach in gastric ulcer. Gastroenterology 57:241, 1968

    Google Scholar 

  109. Black RB, Roberts G, Rhodes J: The effect of healing on bile reflux in gastric ulcer. Gut 12:552, 1971

    Google Scholar 

  110. Ivey KJ: Gastric mucosal barrier. Gastroenterology 61:241, 1971

    Google Scholar 

  111. Franklin MA, Skoryna SC: Studies on natural gastric flora: survival of bacteria in fasting human subjects. Can Med Assoc J 105:380, 1971

    Google Scholar 

  112. Drasar BS, Shiner M, McLeod GM: Studies on the intestinal flora: I. The bacterial flora of the gastrointestinal tract in healthy and achlorhydric persons. Gastroenterology 56:71, 1969

    Google Scholar 

  113. Giannella RA, Broitman SA, Zamcheck N: Gastric acid barrier to ingested microorganisms in man: studiesin vivo andin vitro. Gut 13:251, 1972

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Research Unit of The Walter and Eliza Hall Institute of Medical Research and The Royal Melbourne Hospital, 3050, Victoria, Australia

    R. G. Strickland MD &  I. R. Mackay MD

Authors
  1. R. G. Strickland MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. R. Mackay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Publication No. 1820 from the Walter and Eliza Hall Institute of Medical Research.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Strickland, R.G., Mackay, I.R. A reappraisal of the nature and significance of chronic atrophic gastritis. Digest Dis Sci 18, 426–440 (1973). https://doi.org/10.1007/BF01071995

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01071995

Keywords

  • Gastritis
  • Gastric Carcinoma
  • Iron Deficiency
  • Gastric Ulcer
  • Gastrointestinal Symptom