Mid- and Deep-Zone Gastritis: A Histologic Pattern Associated With Autoimmune Disease but Distinct From Autoimmune Atrophic Gastritis.

Objectives: We sought to characterize a histologic pattern of mid- and deep-zone gastritis, distinct from the typical pattern of Helicobacter pylori or autoimmune gastritis and to see if it had any clinicopathologic association(s).

Methods: We analyzed inflammatory patterns and composition, excluded autoimmune gastritis using immunohistochemistry, and reviewed the medical record for demographics, medical/surgical history, presenting symptoms, endoscopic findings, and medications for 28 cases.

Results: All cases had inflammation in the middle and/or deep mucosal zones with sparing of the superficial/pit compartment. Subfeatures included corpus or antral predominance, pangastric involvement, prominence of a subset(s) of inflammatory cells, and degree of epithelial injury. Of 28 patients, 13 had autoimmune disease(s), autoantibodies, or both. There was no other unifying clinical feature.

Conclusions: This unique pattern of gastritis should be distinguished from other entities such as H pylori and autoimmune gastritis. At least a subset may be an autoimmune condition different from classic autoimmune gastritis.