My Endoscopy Report Says Nodular Gastritis: What Does It Mean?

Nodular gastritis is a granular, bumpy appearance in which the inner surface of the stomach, instead of looking smooth, contains many small raised areas. It is seen most often in the antrum of the stomach.

Nodular gastritis is strongly associated with Helicobacter pylori (H. pylori) infection in particular.

What causes nodular gastritis?

The most important cause is H. pylori infection.

H. pylori can lead to chronic inflammation in the stomach lining and to lymphoid tissue becoming prominent. As a result, the lining can appear at endoscopy as small raised areas.

This appearance is sometimes described as a “goose-flesh” or “chicken-skin” appearance.

In whom is it seen more often?

Nodular gastritis is seen more often in children, adolescents and young adults in particular. Some studies also report it more often in women.

As age advances the typical nodular appearance can become less marked.

Does nodular gastritis mean H. pylori?

It strongly suggests the possibility of H. pylori, but does not on its own make a definite diagnosis.

H. pylori can be investigated by stomach biopsy, a urea breath test or a stool H. pylori antigen test. If a biopsy was taken during the endoscopy, the pathology result matters here.

What symptoms can it cause?

Some patients have no symptoms at all. Others may have pain or burning in the upper abdomen, indigestion, bloating, nausea, early fullness and discomfort after meals.

But these symptoms are not specific to nodular gastritis.

Is a biopsy needed?

Assessment by biopsy is generally useful. A biopsy allows:

• The presence of H. pylori To be looked for directly in the tissue.
• The grade and distribution of the gastritis To be assessed.
• Atrophy or intestinal metaplasia And other accompanying changes to be seen.

A biopsy being taken does not mean there is cancer.

Does nodular gastritis cause cancer?

Nodular gastritis itself is not cancer.

But the long-standing H. pylori infection with which nodular gastritis is often associated is an important factor that can, over the long term, increase the risk of stomach cancer through chronic gastritis, atrophy and intestinal metaplasia.

Some studies have reported an association with diffuse-type stomach cancer in particular. But this does not mean a person with nodular gastritis will develop cancer.

So rather than frightening the patient unnecessarily, what matters is looking for H. pylori and treating it if present.

How is it treated?

If H. pylori is found, appropriate eradication treatment is given.

After treatment, whether H. pylori really has been eliminated should be confirmed at the right time by a method such as a urea breath test or a stool antigen test.

After successful eradication the nodular appearance can lessen or disappear over time.

Is a follow-up endoscopy needed?

Repeating the endoscopy routinely is not needed in every patient with nodular gastritis.

The decision about follow-up is made according to the biopsy result, the presence of atrophy or intestinal metaplasia, whether there is another suspicious lesion, a family history of stomach cancer and the patient’s continuing symptoms.

When should assessment be more careful?

Remember

• Nodular gastritis Is not cancer.
• H. pylori Is very strongly associated with nodular gastritis.
• A biopsy Helps assess H. pylori and any accompanying histological changes.
• If H. pylori is found Treating it and confirming eradication matter.
• A follow-up endoscopy Is not compulsory in every patient.