Verrucous gastritis

Verrucous gastritis, also known as varioliform verrucous gastritis or chronic erosive verrucous gastritis, is a special type of gastritis. It is characterized by recurrent or persistent multiple gastric erosions of unknown cause. The erosions present a characteristic verrucous appearance, mostly distributed in the pyloric gland area and transitional zone, with a few involving the entire stomach. The lesions are round or oval, mostly less than 10 mm in diameter and about 2 mm in height, though some may be strip-shaped. Most raised lesions have a central depressed erosion, appearing light red or covered with a yellow membrane. In typical cases where multiple homogeneous verrucous lesions are seen under gastroscopy, diagnosis is generally not difficult; however, when encountering single or two irregularly raised lesions, differentiation from type II early gastric cancer, polyps, and pseudolymphoma is required. In addition, superficial antral verrucous gastritis may also present with erosions, usually flat-type erosions, but they can also be raised-type erosions, making differentiation from this disease somewhat difficult in such cases. However, superficial antral gastritis is generally associated with bile reflux, Helicobacter pylori infection, or use of non-steroidal anti-inflammatory analgesics, and the number of erosive foci is small. They generally resolve within a few days, weeks, or up to 3 months. The diagnosis of verrucous gastritis mainly relies on endoscopic examination. This disease is unrelated to the currently known causes of verrucous gastritis; earlier studies suggested an allergic mechanism. Its natural course is prolonged and varies among individuals—some resolve within months, while others persist for years. There is no effective treatment regimen; if clinical symptoms are present, treatment may follow that for peptic ulcer disease.