Incidental Finding Of Lymphocytic Gastritis After An Upper Gastrointestinal Bleed

A 27-year-old man with recent electrical burns presented with hematemesis. He was taking nonsteroidal anti-inflammatory drugs for pain. He was started on a proton-pump inhibitor and an esophagogastroduodenoscopy (EGD) showed nodular gastric mucosa and multiple gastric ulcers. Biopsy specimens showed a microscopic pattern of inflammation suggestive of Helicobacter pylori infection, and, although the stain for the organisms was negative, he was treated. Lymphoma was ruled out. The patient returned for a follow-up EGD 8 weeks later, and was asymptomatic at that time. Repeat EGD again showed diffuse nodular gastric mucosa (Figures A and B) and healed ulcers. Biopsy specimens confirmed the diagnosis of lymphocytic gastritis (LG). Subsequent serologic tests for human immunodeficiency virus and celiac disease were negative. LG is rare and is characterized by more than 25 intraepithelial lymphocytes per 100 epithelial cells (Figure C), specifically CD8+ T cells (Figure D). Endoscopically, the gastric mucosa is nodular with hypertrophied rugae, with or without erosions and plaques. Although it has been associated with H pylori infection, celiac disease, human immunodeficiency virus, lymphomas, and microscopic colitis, LG can be idiopathic. The risk of developing primary gastric lymphoma is unknown because the role of LG as a precursor has not been established. If LG is diagnosed, associated illnesses should be treated, otherwise no other management is necessary. Endoscopic surveillance is not recommended.