Gastrite cronica da Helicobacter pylori
L’infezione da Helicobacter pylori determina innanzitutto una gastrite acuta che successivamente, per la persistenza del batterio, diventa cronica. La gastrite cronica da H. pylori viene anche definita gastrite cronica attiva poiché è caratterizzata dalla presenza, nella lamina propria, di granulociti neutrofili oltre alla presenza di cellule dell’infiammazione cronica, quali i linfociti e le plasmacellule. La gastrite cronica da H. pylori interessa in genere sia l’ antro sia il corpo gastrico. L‘eradicazione dell’infezione con una terapia antibiotica si associa a un immediato miglioramento della gastrite caratterizzato dalla scomparsa dei neutrofili e da una marcata riduzione dei linfociti e delle plasmacellule. Si passa così da una gastrite cronica attiva a una gastrite cronica cosiddetta “quiescente”, e nel corso degli anni si può avere anche una restitutio ad integrum della mucosa.
La gastrite cronica da H. pylori nella maggior parte dei casi è asintomatica. In una piccola parte dei soggetti infettati può progredire verso l’atrofia e la metaplasia intestinale ed eventualmente verso il cancro gastrico, o più raramente, per la persistente stimolazione immunitaria dei follicoli linfatici gastrici, verso il linfoma gastrico. Non è ancora completamente chiaro quali siano i fattori responsabili di queste diverse conseguenze cliniche. L’ H.pylori è un batterio caratterizzato da un’ampia variabilità genetica ed esistono dei ceppi più virulenti e aggressivi di altri che producono più severi danni alla mucosa gastroduodenale. I soggetti infettati possono presentare una diversa predisposizione genetica a sviluppare patologie gastroduodenali, come l’ulcera peptica o il cancro gastrico. Ed è probabilmente proprio l’interazione tra i fattori genetici di virulenza del ceppo e la predisposizione genetica del soggetto a determinare se l’infezione produrrà una semplice gastrite cronica asintomatica, come avviene nella maggior parte dei casi, o anche una patologia del tratto digestivo superiore, come un ulcera peptica o una neoplasia gastrica.
Gastrite atrofica autoimmune del corpo ( o di tipo A)
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