“Antral gastritis” and “pangastritis” appear quite often on gastroscopy reports. These terms describe first of all which regions of the stomach lining show the changes.
“Antral gastritis” or “pangastritis” on a report does not on its own mean cancer.
What does antral gastritis mean?
The antrum is the outlet part of the stomach, the part nearest the pylorus.
If redness, swelling, erosion or other changes consistent with gastritis are seen particularly in this region at endoscopy, the report may use the phrase “antral gastritis”.
In short: antral gastritis → the changes are mainly in the antrum of the stomach.
What does pangastritis mean?
The word “pan” means all, or widespread.
When changes consistent with gastritis are seen not only in the antrum but widely across different parts of the stomach, such as the antrum and the corpus, it is called pangastritis.
In short: pangastritis → changes consistent with gastritis involve a wider part of the stomach.
The word “pangastritis” does not necessarily mean “very severe gastritis”. Extent and severity are not the same thing.
What causes it?
Different causes can lie behind antral gastritis or pangastritis:
- Helicobacter pylori (H. pylori) infection
- Aspirin and NSAID painkillers
- Bile reflux
- Alcohol
- Autoimmune gastritis
- Other conditions affecting the stomach lining
H. pylori in particular is one of the important causes of chronic gastritis.
Does antral gastritis mean H. pylori?
No.
H. pylori can often cause marked gastritis in the antrum; but seeing “antral gastritis” at endoscopy does not show that H. pylori is definitely present.
H. pylori is investigated with appropriate tests or, where needed, by biopsy.
What symptoms can it cause?
Some people 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 gastritis. Similar complaints can occur in functional dyspepsia, reflux and other gastrointestinal conditions.
Is seeing gastritis at endoscopy a definite diagnosis of gastritis?
There is an important distinction here. Endoscopy assesses the appearance of the stomach lining; biopsy assesses microscopic inflammation in the tissue.
- Endoscopy Shows how the lining looks.
- Biopsy Assesses histological gastritis.
It is possible for the biopsy to be normal despite redness at endoscopy, and equally for a biopsy to show chronic gastritis while the stomach looks quite normal at endoscopy.
Why is a biopsy taken?
Where it is thought necessary, a biopsy may be taken to look for H. pylori, to assess the histological features of the gastritis, to look for atrophic gastritis, to assess intestinal metaplasia, or to examine a suspicious area.
A biopsy being taken does not mean there is cancer.
Is pangastritis more dangerous than antral gastritis?
Not always.
Pangastritis says the changes are more widespread; it does not on its own show the condition is more dangerous.
What really matters are findings such as the cause of the gastritis + the biopsy result + H. pylori + atrophy + intestinal metaplasia + any erosions.
How is it treated?
Treatment is determined not by the word “antral” or “pan” but by the cause of the gastritis.
If H. pylori is found, eradication treatment may be given. If NSAIDs or aspirin are being taken, these are assessed. If bile reflux or another cause is suspected, the approach changes accordingly.
Prescribed aspirin or blood-thinning medicines should not be stopped without speaking to your doctor.
Is a follow-up endoscopy needed?
Not in every patient with antral gastritis or pangastritis.
The need for follow-up is determined more by atrophic gastritis, intestinal metaplasia, an ulcer, a suspicious lesion, continuing symptoms or other risk factors.
The words “antral gastritis” or “pangastritis” on a report are generally not in themselves enough reason for regular gastroscopy.
When should more care be taken?
More detailed assessment is needed if gastritis is accompanied by
Vomiting blood · black, tarry stools · unexplained iron deficiency or anaemia · persistent vomiting · difficulty swallowing · unintended weight loss.
Remember
- Antral gastritis Changes consistent with gastritis are mainly in the antrum.
- Pangastritis The changes have spread to a wider part of the stomach.
- Being widespread Does not necessarily mean more severe or more dangerous.
- H. pylori Is one of the important causes, but not every gastritis is due to it.
- A biopsy Can give more detailed information about the type of gastritis and any accompanying changes.
- Antral gastritis / pangastritis Is not on its own cancer.
This is not enough to make a diagnosis
When antral gastritis or pangastritis is seen at endoscopy, the endoscopic appearance, H. pylori status, the medicines being taken and any biopsy result all have to be weighed together.
Sources
- Prof. Ali Tüzün İnce, MD