Skip Navigation LinksHome > August 2010 - Volume 51 - Issue 2 > Endoscopic Portrayal of Lymphocytic Gastritis in a Child
Text sizing:
A
A
A
Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3181e2c70e
Image of the Month

Endoscopic Portrayal of Lymphocytic Gastritis in a Child

Deb, Pooja MPH; Jibaly, Rima MD

Free Access
Article Outline
Collapse Box

Author Information

College of Human Medicine, Michigan State University, East Lansing.

Address correspondence and reprint requests to Pooja Deb, 18209 Thornridge Dr, Grand Blanc, MI 48439 (e-mail: poojadeb@gmail.com).

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 14-year-old girl presented for endoscopic examination after 4 months of abdominal pain in the right upper quadrant and epigastric area. The endoscopic examination showed a spectacular rash of raised erythematous aphthoid-like ulcerations with a white coating (Fig. 1). Histologic study showed intense superficial plasmacytosis and overlying regions of lymphocytic congestion consistent with the diagnosis of lymphocytic gastritis (LG), first defined by Haot et al in 1985 (1), >25 intraepithelial lymphocytes/100 epithelial cells (Figs 2 and 3) (2). The patient's biopsies were found to be negative for celiac disease and Helicobacter pylori. Her symptoms improved with sucralfate and Prevacid. She later developed worsening right upper quadrant pain and was diagnosed as having chronic cholecystitis. Postcholecystectomy, the repeat endoscopic and histologic examination done for residual abdominal pain showed resolution of LG.

Figure 1
Figure 1
Image Tools
Figure 2
Figure 2
Image Tools
Figure 3
Figure 3
Image Tools

Although we do not understand the pathogenesis of LG, this case may be related to 1 of the proposed etiologies of LG involving immunologic intolerance of the gastric mucosa to environmental agents (3). The patient most likely had resolution of her findings with the removal of the offending agent. At this point we are unable to predict at what stage in the pathologic process the gross and/or the microscopic findings of LG will be apparent (4). It may be related to the acuteness and severity of the insult, or the phase of the disease process. In the future, including endoscopic examination of gross pathology in investigations of LG may help to further define the natural history of the disease. This case does not represent any of the known causes of LG (3,5–8). In this patient the role of cholecystitis is not clear.

Back to Top | Article Outline

REFERENCES

1. Haot J, Wallez L, Jouret-Mourin A, et al. Lymphocytic gastritis. A new entity. Acta Endosc 1985; 15:187–188.

2. Dixon MF, Genta RM, Yardely JH, et al. Classification and grading of gastritis: the updated Sydney system. Am J Surg Pathol 1996; 20:1161–1181.

3. Prasad K, Thapa B, Lal S, et al. Lymphocytic gastritis and celiac disease in Indian children: evidence of a positive relation. J Pediatr Gastroenterol Nutr 2008; 47:568–572.

4. Haot J, Hamichi L, Wallez L, et al. Lymphocytic gastritis: a newly described entity: a retrospective endoscopic and histological study. Gut 1988; 29:1258–1264.

5. Wolber R, Owen D, DelBuono L, et al. Lymphocytic gastritis in patients with celiac sprue or spruelike intestinal disease. Gastroenterology 1990; 98:310–315.

6. Luzza F, Mancuso M, Imeneo M, et al. Helicobacter pylori infection in children with celiac disease: prevalence and clinicopathologic features. J Pediatr Gastroenterol Nutr 1999; 28:143–146.

7. Yutaka S, Mukai M, Asato Y, et al. Clinical and endoscopic improvement of lymphocytic gastritis with eradication of Helicobacter pylori. Gastroint Endosc 2001; 54:251–255.

8. Montagnac R, Blaison D, Ciupea A, et al. A rare cause of peripheral edema: exudative lymphocytic gastritis induced hypoprotidemia. Nephrol Ther 2007; 3:107–112.

Copyright 2010 by ESPGHAN and NASPGHAN

Login

Article Tools

Images

Share

Connect With Us

 

 

Twitter

twitter.com/JPGNonline

 

Visit JPGN.org on your smartphone. Scan this code (QR reader app required) with your phone and be taken directly to the site.