Gastric atrophy, intestinal metaplasia and dysplasia
- Process
Years of gastritis can thin the stomach lining, turn it gut-like and then produce abnormal cells that come before cancer.
What it is
Chronic gastritis of any cause can follow a slow path: glands are lost (atrophy), the lining is replaced by intestinal-type epithelium (metaplasia), and genetic damage accumulates until the epithelium becomes dysplastic. This sequence, best known in H. pylori infection, precedes intestinal-type gastric adenocarcinoma. Gastritis cystica is a separate reactive lesion in which cysts are trapped in the wall and can mimic invasive cancer.
Structure
- Atrophy: thin mucosa with few glands and loss of rugae.
- Intestinal metaplasia: goblet cells, absorptive cells and sometimes Paneth cells in gastric pits.
- Dysplasia: crowded, elongated or rounded hyperchromatic nuclei extending to the surface.
- Gastritis cystica: dilated epithelial-lined cysts in the submucosa or muscle with regenerative change.
Step by step
- Chronic inflammation (H. pylori, autoimmunity) damages glands.
- Parietal and chief cells are lost: atrophy.
- Intestinal-type epithelium with goblet cells replaces gastric glands: metaplasia.
- Free radicals, regeneration and gastrin drive mutations: low-grade then high-grade dysplasia.
- Invasion through the basement membrane: intestinal-type adenocarcinoma.
Clinical notes
- This sequence explains why gastric cancer is common where H. pylori is common, as in the Colombian Andes.
- Gastritis cystica profunda must not be mistaken for invasive carcinoma on biopsy.
Test yourself
Think of the answer, then tap the question to see it.
What histologic finding defines intestinal metaplasia of the stomach?
Goblet cells (with absorptive and sometimes Paneth cells) replacing gastric epithelium.
How does the pathologist distinguish dysplasia from reactive change?
Reactive epithelium matures as it reaches the surface; dysplastic epithelium stays immature and atypical to the surface.
Why can gastritis cystica be mistaken for cancer?
Epithelial-lined cysts entrapped deep in the gastric wall, with regenerative atypia, look like invasion.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Gastric Cancer (StatPearls (NCBI Bookshelf), 2025); Helicobacter Pylori (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.