Pattern-based approach to gastritis and gastropathy

Česká verzia

Authors: Ondřej Daum ^1,2 ; Magdaléna Daumová ^1,2; Marián Švajdler ^1,2
Authors place of work: Šiklův ústav patologie LF UK a FN Plzeň ¹; Bioptická laboratoř s. r. o., Plzeň ²
Published in the journal: Čes.-slov. Patol., 58, 2022, No. 2, p. 77-87
Category: Reviews Article

Summary

Histological investigation of non-neoplastic endoscopic biopsies of gastric mucosa is one of the most common tasks most pathologists have to face on daily basis. Although the most common clinical question is still being whether Helicobacter organisms are found, pathologists have to bear in mind the whole spectrum of causes and associated morphological patterns of gastritides and gastropathies, governed by characteristic combinations of various types of inflammatory infiltrate, alterative and reactive changes of epithelial component, vascular response, and variability of stromal composition. The association of histopathologic pattern with supposed etiology can be sometimes proved by direct detection of the cause of morphologic changes in the investigated endoscopic sample.

Keywords:

endoscopy – Biopsy – Stomach – Gastritis – gastropathy – pattern

Zdroje

1. Daum O. Patologie GIT. In: Zámečník J, ed. Patologie (1. vydání). Prague: LD, s.r.o. - PRAGER PUBLISHING; 2019: 461-526.

2. El-Zimaity HM, Al-Assi MT, Genta RM, Graham DY. Confirmation of successful therapy of Helicobacter pylori infection: number and site of biopsies or a rapid urease test. Am J Gastroenterol 1995; 90(11): 1962-1964.

3. El-Zimaity HM, Graham DY. Evaluation of gastric mucosal biopsy site and number for identification of Helicobacter pylori or intestinal metaplasia: role of the Sydney System. Hum Pathol 1999; 30(1): 72-77.

4. Kuipers EJ, Uyterlinde AM, Pena AS, et al. Increase of Helicobacter pylori-associated corpus gastritis during acid suppressive therapy: implications for long-term safety. Am J Gastroenterol 1995; 90(9): 1401-1406.

5. Kuipers EJ, Lundell L, Klinkenberg-Knol EC, et al. Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. N Engl J Med 1996; 334(16): 1018-1022.

6. Graham DY, Opekun AR, Yamaoka Y, Osato MS, El-Zimaity HM. Early events in proton pump inhibitor-associated exacerbation of corpus gastritis. Aliment Pharmacol Ther 2003; 17(2): 193-200.

7. Genta RM, Rindi G, Fiocca R, et al. Effects of 6-12 months of esomeprazole treatment on the gastric mucosa. Am J Gastroenterol 2003; 98(6): 1257-1265.

8. Stolte M, Kroher G, Meining A, et al. A comparison of Helicobacter pylori and H. heilmannii gastritis. A matched control study involving 404 patients. Scand J Gastroenterol 1997; 32(1): 28-33.

9. Priestnall SL, Wiinberg B, Spohr A, et al. Evaluation of “Helicobacter heilmannii” subtypes in the gastric mucosas of cats and dogs. J Clin Microbiol 2004; 42(5): 2144-2151.

10. Batts KP, Ketover S, Kakar S, et al. Appropriate use of special stains for identifying Helicobacter pylori: recommendations from the Rodger C. Haggitt Gastrointestinal Pathology Society. Am J Surg Pathol 2013; 37(11): e12-22.

11. Panarelli NC, Ross DS, Bernheim OE, et al. Utility of ancillary stains for Helicobacter pylori in near-normal gastric biopsies. Hum Pathol 2015; 46(3): 397-403.

12. Chitkara Y. Upfront special staining for Helicobacter pylori in gastric biopsy specimens is not indicated. Am J Clin Pathol 2015; 143(1): 84-88.

13. Pittman ME, Khararjian A, Wood LD, Montgomery EA, Voltaggio L. Prospective identification of Helicobacter pylori in routine gastric biopsies without reflex ancillary stains is cost-efficient for our health care system. Hum Pathol 2016; 58: 90-96.

14. Jessurun J. Helicobacter pylori: an evolutionary perspective. Histopathology 2021; 78(1): 39-47.

15. Dellon ES, Peery AF, Shaheen NJ, et al. Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database. Gastroenterology 2011; 141(5): 1586-1592.

16. Shah SC, Tepler A, Peek RM, Jr., et al. Association between Helicobacter pylori exposure and decreased odds of eosinophilic esophagitis. A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2019; 17(11): 2185- 2198.

17. Raghunath A, Hungin AP, Wooff D, Childs S. Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ 2003; 326(7392): 737.

18. Mou WL, Feng MY, Hu LH. Eradication of Helicobacter pylori infections and GERD: A systematic review and meta-analysis. Turk J Gastroenterol 2020; 31(12): 853-859.

19. Zhao Y, Li Y, Hu J, et al. The effect of Helicobacter pylori eradication in patients with gastroesophageal reflux disease: A meta-analysis of randomized controlled studies. Dig Dis 2020; 38(4): 261-268.

20. Quach DT, Pham QTT, Tran TLT, et al. Clinical characteristics and risk factors of gastroesophageal reflux disease in Vietnamese patients with upper gastrointestinal symptoms undergoing esophagogastroduodenoscopy. JGH Open 2021; 5(5): 580-584.

21. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142(1): 46-54.

22. Castano-Rodriguez N, Kaakoush NO, Lee WS, Mitchell HM. Dual role of Helicobacter and Campylobacter species in IBD: a systematic review and meta-analysis. Gut 2017; 66(2): 235-249.

23. Pellicano R, Ianiro G, Fagoonee S, Settanni CR, Gasbarrini A. Review: Extragastric diseases and Helicobacter pylori. Helicobacter 2020; 25 (Suppl. 1): e12741.

24. Ding ZH, Xu XP, Wang TR, et al. The prevalence of Helicobacter pylori infection in inflammatory bowel disease in China: A case-control study. PloS One 2021; 16(3): e0248427.

25. Chen C, Xun P, Tsinovoi C, He K. Accumulated evidence on Helicobacter pylori infection and the risk of asthma: A meta-analysis. Ann Allergy Asthma Immunol 2017; 119(2): 137- 145.

26. Sheh A, Chaturvedi R, Merrell DS, et al. Phylogeographic origin of Helicobacter pylori determines host-adaptive responses upon coculture with gastric epithelial cells. Infect Immun 2013; 81(7): 2468-2477.

27. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20(10): 1161-1181.

28. Jhala NC, Montemor M, Jhala D, et al. Pancreatic acinar cell metaplasia in autoimmune gastritis. Arch Pathol Lab Med 2003; 127(7): 854-857.

29. Pittman ME, Voltaggio L, Bhaijee F, Robertson SA, Montgomery EA. Autoimmune metaplastic atrophic gastritis: recognizing precursor lesions for appropriate patient evaluation. Am J Surg Pathol 2015; 39(12): 1611-1620.

30. Lewin KJ, Dowling F, Wright JP, Taylor KB. Gastric morphology and serum gastrin levels in pernicious anaemia. Gut 1976; 17(7): 551- 560.

31. Appelmelk BJ, Faller G, Claeys D, Kirchner T, Vandenbroucke-Grauls CM. Bugs on trial: the case of Helicobacter pylori and autoimmunity. Immunol Today 1998; 19(7): 296-299.

32. Minalyan A, Benhammou JN, Artashesyan A, Lewis MS, Pisegna JR. Autoimmune atrophic gastritis: current perspectives. Clin Exp Gastroenterol 2017; 10: 19-27.

33. Jevremovic D, Torbenson M, Murray JA, Burgart LJ, Abraham SC. Atrophic autoimmune pangastritis: A distinctive form of antral and fundic gastritis associated with systemic autoimmune disease. Am J Surg Pathol 2006; 30(11): 1412-1419.

34. Speck O, Appelman HD, Owens SR. Midand deep-zone gastritis: a histologic pattern associated with autoimmune disease but distinct from autoimmune atrophic gastritis. Am J Clin Pathol 2018; 150(4): 364-374.

35. Mitomi H, Tanabe S, Igarashi M, et al. Autoimmune enteropathy with severe atrophic gastritis and colitis in an adult: proposal of a generalized autoimmune disorder of the alimentary tract. Scand J Gastroenterol 1998; 33(7): 716-720.

36. Xin W, Greenson JK. The clinical significance of focally enhanced gastritis. Am J Surg Pathol 2004; 28(10): 1347-1351.

37. Horjus Talabur Horje CS, Meijer J, Rovers L, et al. Prevalence of upper gastrointestinal lesions at primary diagnosis in adults with inflammatory bowel disease. Inflamm Bowel Dis 2016; 22(8): 1896-1901.

38. Zhang Y, Molot R. Severe gastritis secondary to Epstein-Barr viral infection. Unusual presentation of infectious mononucleosis and associated diffuse lymphoid hyperplasia in gastric mucosa. Arch Pathol Lab Med 2003; 127(4): 478-480.

39. Chen ZM, Shah R, Zuckerman GR, Wang HL. Epstein-Barr virus gastritis: an underrecognized form of severe gastritis simulating gastric lymphoma. Am J Surg Pathol 2007; 31(9): 1446-1451.

40. Greenstein DB, Wilcox CM, Schwartz DA. Gastric syphilis. Report of seven cases and review of the literature. J Clin Gastroenterol 1994; 18(1): 4-9.

41. Long BW, Johnston JH, Wetzel W, Flowers RH, 3rd, Haick A. Gastric syphilis: endoscopic and histological features mimicking lymphoma. Am J Gastroenterol 1995; 90(9): 1504- 1507.

42. Mylona EE, Baraboutis IG, Papastamopoulos V, et al. Gastric syphilis: a systematic review of published cases of the last 50 years. Sex Transm Dis 2010; 37(3): 177-183.

43. Wu TT, Hamilton SR. Lymphocytic gastritis: association with etiology and topology. Am J Surg Pathol 1999; 23(2): 153-158.

44. Feeley KM, Heneghan MA, Stevens FM, Mc- Carthy CF. Lymphocytic gastritis and coeliac disease: evidence of a positive association. J Clin Pathol 1998; 51(3): 207-210.

45. Rubio-Tapia A, Herman ML, Ludvigsson JF, et al. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc 2012; 87(8): 732-738.

46. Ruget O, Burtin P, Cerez H, Cales P, Boyer J. Diarrhee chronique associee a une atrophie villositaire et une gastrite lymphocytaire, imputable a la ticlopidine. Gastroenterol Clin Biol 1992; 16(3): 290.

47. Muir A, Surrey L, Kriegermeier A, Shaikhkalil A, Piccoli DA. Severe eosinophilic gastroenteritis in a Crohn’s disease patient treated with infliximab and adalimumab. Am J Gastroenterol 2016; 111(3): 437-438.

48. Colletti RB, Trainer TD. Collagenous gastritis. Gastroenterology 1989; 97(6): 1552-1555.

49. Vesoulis Z, Lozanski G, Ravichandran P, Esber E. Collagenous gastritis: a case report, morphologic evaluation, and review. Mod Pathol 2000; 13(5): 591-596.

50. Arnason T, Brown IS, Goldsmith JD, et al. Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients. Mod Pathol 2015; 28(4): 533-544.

51. Stancu M, De Petris G, Palumbo TP, Lev R. Collagenous gastritis associated with lymphocytic gastritis and celiac disease. Arch Pathol Lab Med 2001; 125(12): 1579-1584.

52. Lagorce-Pages C, Fabiani B, Bouvier R, et al. Collagenous gastritis: a report of six cases. Am J Surg Pathol 2001; 25(9): 1174-1179.

53. Ma C, Park JY, Montgomery EA, et al. A comparative clinicopathologic study of collagenous gastritis in children and adults: the same disorder with associated immune-mediated diseases. Am J Surg Pathol 2015; 39(6): 802-812.

54. Mandaliya R, Burkart AL, DiMarino AJ, Rattan S, Cohen S. Association between common variable immunodeficiency and collagenous infiltrative disorders of the gastrointestinal tract: A series of four patients. Indian J Gastroenterol 2016; 35(2): 133-138.

55. Anwar MS, Aamar A, Marhaba A, Sidhu JS. Collagenous gastritis in a young female with IgA deficiency. Gastroenterology Res 2017; 10(2): 126-127.

56. Al-Kandari A, Al-Alardati H, Sayadi H, Al-Judaibi B, Mawardi M. An unusual case of collagenous gastritis in a middle-aged woman with systemic lupus erythromatosus: a case report. J Med Case Rep 2014; 8: 278.

57. Leung ST, Chandan VS, Murray JA, Wu TT. Collagenous gastritis: histopathologic features and association with other gastrointestinal diseases. Am J Surg Pathol 2009; 33(5): 788-798.

58. Castellano VM, Munoz MT, Colina F, et al. Collagenous gastrobulbitis and collagenous colitis. Case report and review of the literature. Scand J Gastroenterol 1999; 34(6): 632-638.

59. Pulimood AB, Ramakrishna BS, Mathan MM. Collagenous gastritis and collagenous colitis: a report with sequential histological and ultrastructural findings. Gut 1999; 44(6): 881-885.

60. Genta RM, Lew GM, Graham DY. Changes in the gastric mucosa following eradication of Helicobacter pylori. Mod Pathol 1993; 6(3): 281-289.

61. Pusztaszeri MP, Genta RM, Cryer BL. Drug-induced injury in the gastrointestinal tract: clinical and pathologic considerations. Nat Clin Pract Gastroenterol Hepatol 2007; 4(8): 442-453.

62. DeBrosse CW, Case JW, Putnam PE, Collins MH, Rothenberg ME. Quantity and distribution of eosinophils in the gastrointestinal tract of children. Pediatr Dev Pathol 2006; 9(3): 210-218.

63. Talley NJ, Walker MM, Aro P, et al. Non-ulcer dyspepsia and duodenal eosinophilia: an adult endoscopic population-based case-control study. Clin Gastroenterol Hepatol 2007; 5(10): 1175-1183.

64. Lwin T, Melton SD, Genta RM. Eosinophilic gastritis: histopathological characterization and quantification of the normal gastric eosinophil content. Mod Pathol 2011; 24(4): 556- 563.

65. Ko HM, Morotti RA, Yershov O, Chehade M. Eosinophilic gastritis in children: clinicopathological correlation, disease course, and response to therapy. Am J Gastroenterol 2014; 109(8): 1277-1285.

66. Matsushita T, Maruyama R, Ishikawa N, et al. The number and distribution of eosinophils in the adult human gastrointestinal tract: a study and comparison of racial and environmental factors. Am J Surg Pathol 2015; 39(4): 521-527.

67. Barak N, Hart J, Sitrin MD. Enalapril-induced eosinophilic gastroenteritis. J Clin Gastroenterol 2001; 33(2): 157-158.

68. Barbie DA, Mangi AA, Lauwers GY. Eosinophilic gastroenteritis associated with systemic lupus erythematosus. J Clin Gastroenterol 2004; 38(10): 883-886.

69. Miller AI, Smith B, Rogers AI. Phlegmonous gastritis. Gastroenterology 1975; 68(2): 231- 238.

70. Schultz MJ, van der Hulst RW, Tytgat GN. Acute phlegmonous gastritis. Gastrointest Endosc 1996; 44(1): 80-83.

71. Lifton LJ, Schlossberg D. Phlegmonous gastritis after endoscopic polypectomy. Ann Intern Med 1982; 97(3): 373-375.

72. Mittleman RE, Suarez RV. Phlegmonous gastritis associated with the acquired immunodeficiency syndrome/pre-acquired immunodeficiency syndrome. Arch Pathol Lab Med 1985; 109(8): 765-767.

73. Stein LB, Greenberg RE, Ilardi CF, Kurtz L, Bank S. Acute necrotizing gastritis in a patient with peptic ulcer disease. Am J Gastroenterol 1989; 84(12): 1552-1554.

74. Kim GY, Ward J, Henessey B, et al. Phlegmonous gastritis: case report and review. Gastrointest Endosc 2005; 61(1): 168-174.

75. Oberhuber G, Puspok A, Oesterreicher C, et al. Focally enhanced gastritis: a frequent type of gastritis in patients with Crohn’s disease. Gastroenterology 1997; 112(3): 698-706.

76. Meining A, Bayerdorffer E, Bastlein E, et al. Focal inflammatory infiltrations in gastric biopsy specimens are suggestive of Crohn’s disease. Crohn’s Disease Study Group, Germany. Scand J Gastroenterol 1997; 32(8): 813-818.

77. Oberhuber G, Hirsch M, Stolte M. High incidence of upper gastrointestinal tract involvement in Crohn’s disease. Virchows Arch 1998; 432(1): 49-52.

78. Sharif F, McDermott M, Dillon M, et al. Focally enhanced gastritis in children with Crohn’s disease and ulcerative colitis. Am J Gastroenterol 2002; 97(6): 1415-1420.

79. Kundhal PS, Stormon MO, Zachos M, et al. Gastral antral biopsy in the differentiation of pediatric colitides. Am J Gastroenterol 2003; 98(3): 557-561.

80. Lin J, McKenna BJ, Appelman HD. Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis: a controlled study. Am J Surg Pathol 2010; 34(11): 1672-1677.

81. Ushiku T, Moran CJ, Lauwers GY. Focally enhanced gastritis in newly diagnosed pediatric inflammatory bowel disease. Am J Surg Pathol 2013; 37(12): 1882-1888.

82. Torrente F, Anthony A, Heuschkel RB, et al. Focal-enhanced gastritis in regressive autism with features distinct from Crohn’s and Helicobacter pylori gastritis. Am J Gastroenterol 2004; 99(4): 598-605.

83. Brown I, Kumarasinghe MP. Granulomas in the gastrointestinal tract: deciphering the Pandora’s box. Virchows Arch 2018; 472(1): 3-14.

84. Ectors NL, Dixon MF, Geboes KJ, et al. Granulomatous gastritis: a morphological and diagnostic approach. Histopathology 1993; 23(1): 55-61.

85. Dhillon AP, Sawyerr A. Granulomatous gastritis associated with Campylobacter pylori. APMIS 1989; 97(8): 723-727.

86. Shapiro JL, Goldblum JR, Petras RE. A clinicopathologic study of 42 patients with granulomatous gastritis. Is there really an “idiopathic” granulomatous gastritis? Am J Surg Pathol 1996; 20(4): 462-470.

87. Miyamoto M, Haruma K, Yoshihara M, et al. Isolated granulomatous gastritis successfully treated by Helicobacter pylori eradication: a possible association between granulomatous gastritis and Helicobacter pylori. J Gastroenterol 2003; 38(4): 371-375.

88. Maeng L, Lee A, Choi K, Kang CS, Kim KM. Granulomatous gastritis: a clinicopathologic analysis of 18 biopsy cases. Am J Surg Pathol 2004; 28(7): 941-945.

89. Sandmeier D, Bouzourene H. Does idiopathic granulomatous gastritis exist? Histopathology 2005; 46(3): 352-353.

90. Dewar EP, Dixon MF, Johnston D. Bile reflux and degree of gastritis after highly selective vagotomy, truncal vagotomy, and partial gastrectomy for duodenal ulcer. World J Surg 1983; 7(6): 743-750.

91. Dixon MF, O’Connor HJ, Axon AT, King RF, Johnston D. Reflux gastritis: distinct histopathological entity? J Clin Pathol 1986; 39(5): 524-530.

92. Graham DY, Smith JL. Gastroduodenal complications of chronic NSAID therapy. Am J Gastroenterol 1988; 83(10): 1081-1084.

93. Sobala GM, King RF, Axon AT, Dixon MF. Reflux gastritis in the intact stomach. J Clin Pathol 1990; 43(4): 303-306.

94. Hawkey CJ. Nonsteroidal anti-inflammatory drug gastropathy. Gastroenterology 2000; 119(2): 521-535.

95. Dixon MF. Reflux gastritis. Acta Gastroenterol Belg 1989; 52(3-4): 292-296.

96. Quinn CM, Bjarnason I, Price AB. Gastritis in patients on non-steroidal anti-inflammatory drugs. Histopathology 1993; 23(4): 341-348.

97. El-Zimaity HM, Genta RM, Graham DY. Histological features do not define NSAID-induced gastritis. Hum Pathol 1996; 27(12): 1348-1354.

98. Vieth M, Muller H, Stolte M. Can the diagnosis of NSAID-induced or HP-associated gastric ulceration be predicted from histology? Z Gastroenterol 2002; 40(9): 783-788.

99. McCormack TT, Sims J, Eyre-Brook I, et al. Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy? Gut 1985; 26(11): 1226-1232.

100. Quintero E, Pique JM, Bombi JA, et al. Gastric mucosal vascular ectasias causing bleeding in cirrhosis. A distinct entity associated with hypergastrinemia and low serum levels of pepsinogen I. Gastroenterology 1987; 93(5): 1054-1061.

101. Zhou Y, Chen G, Chen H, et al. Portal hypertensive gastropathy or gastric antral vascular ectasia: is an accurate diagnosis possible on histology? Mod Pathol 2016; 29(Suppl. 2): 211A.

102. Moss SF, Sordillo EM, Abdalla AM, et al. Increased gastric epithelial cell apoptosis associated with colonization with cagA + Helicobacter pylori strains. Cancer Res 2001; 61(4): 1406-1411.

103. Snover DC, Weisdorf SA, Vercellotti GM, et al. A histopathologic study of gastric and small intestinal graft-versus-host disease following allogeneic bone marrow transplantation. Hum Pathol 1985; 16(4): 387-392.

104. Washington K, Bentley RC, Green A, et al. Gastric graft-versus-host disease: a blinded histologic study. Am J Surg Pathol 1997; 21(9): 1037-1046.

105. Epstein RJ, McDonald GB, Sale GE, Shulman HM, Thomas ED. The diagnostic accuracy of the rectal biopsy in acute graft-versus-host disease: a prospective study of thirteen patients. Gastroenterology 1980; 78(4): 764-771.

106. Parfitt JR, Jayakumar S, Driman DK. Mycophenolate mofetil-related gastrointestinal mucosal injury: variable injury patterns, including graft-versus-host disease-like changes. Am J Surg Pathol 2008; 32(9): 1367-1372.

107. Johncilla M, Grover S, Zhang X, Jain D, Srivastava A. Morphological spectrum of immune check-point inhibitor therapy-associated gastritis. Histopathology 2020; 76(4): 531-539.

108. Zhang ML, Neyaz A, Patil D, et al. Immune- related adverse events in the gastrointestinal tract: diagnostic utility of upper gastrointestinal biopsies. Histopathology 2020; 76(2): 233-243.

109. Iacobuzio-Donahue CA, Lee EL, Abraham SC, Yardley JH, Wu TT. Colchicine toxicity: distinct morphologic findings in gastrointestinal biopsies. Am J Surg Pathol 2001; 25(8): 1067-1073.

110. Langner C, Ott A. Possible pitfall in diagnosis: mitotic arrest of gastric epithelium after docetaxel therapy for hormone-refractory prostatic cancer. Histopathology 2007; 51(1): 111-113.

111. Parfitt JR, Driman DK. Pathological effects of drugs on the gastrointestinal tract: a review. Hum Pathol 2007; 38(4): 527-536.

112. Abraham SC, Yardley JH, Wu TT. Erosive injury to the upper gastrointestinal tract in patients receiving iron medication: an underrecognized entity. Am J Surg Pathol 1999; 23(10): 1241-1247.

113. Haig A, Driman DK. Iron-induced mucosal injury to the upper gastrointestinal tract. Histopathology 2006; 48(7): 808-812.

114. Marginean EC, Bennick M, Cyczk J, Robert ME, Jain D. Gastric siderosis: patterns and significance. Am J Surg Pathol 2006; 30(4): 514- 520.

115. Makino M, Kawaguchi K, Shimojo H, et al. Extensive lanthanum deposition in the gastric mucosa: the first histopathological report. Pathol Int 2015; 65(1): 33-37.

116. Gorospe M, Fadare O. Gastric mucosal calcinosis: clinicopathologic considerations. Adv Anat Pathol 2007; 14(3): 224-228.

117. Greenson JK, Trinidad SB, Pfeil SA, et al. Gastric mucosal calcinosis. Calcified aluminum phosphate deposits secondary to aluminum- containing antacids or sucralfate therapy in organ transplant patients. Am J Surg Pathol 1993; 17(1): 45-50.

118. Matsukuma K, Gui D, Olson KA, et al. Osmo- Prep-associated gastritis: a histopathologic mimic of iron pill gastritis and mucosal calcinosis. Am J Surg Pathol 2016; 40(11): 1550- 1556.

119. Gonzalez RS, Lagana SM, Szeto O, Arnold CA. Challenges in diagnosing medication resins in surgical pathology specimens: a crystal-clear review guide. Arch Pathol Lab Med 2017; 141(9): 1276-1282.