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During 8 years experience, 90 cases of diffuse varioliform gastritis were observed (0.3% of examinations). Symptoms suggest either the presence of a gastroduodenal ulcer or of a digestive carcinoma when weight loss is prevalent. The disease proceeds by subacute evolutive bouts with remissions and further relapses. At endoscopy, lesions associate large folds in the fundus and erosive mucosal bulgings disseminated in the fundus and antrum. Histological alterations correspond to a superficial hyperplasic gastritis. Cellular infiltration of the lamina propria includes increased immunocytes population with an abnormal distribution of immunoglobulin classes. An increased percentage of IgE cells characterizes the disease as compared to inflammation in atrophic gastritis. Therapy is based upon agent inhibiting mastocytes degranulation and histamine antagonists. Diffuse varioliform gastritis must be separated from antral varioliform gastritis, a lesion with a higher frequency but no symptomatic individuality.

SUMMARY Eighteen patients with diffuse varioliform gastritis were enrolled in a double-blind, placebo-controlled trial of sodium cromoglycate, 200 mg a day, and sodium cromoglycate, 400 mg a day, for 28 days. An additional six patients were treated with cimetidine 1 g daily for 28 days. The improvement in terms of patient's subjective assessment, endoscopic assessment, and immunohistochemical measurements of IgE cells in the mucosa was significantly greater in patients given sodium cromoglycate than that in those given cimetidine or placebo. The results provide evidence that type 1 hypersensitivity plays some part in the pathogenesis of varioliform gastritis. It is, therefore, important to differentiate this condition from other types of gastritis, as treatment with sodium cromoglycate appears to be effective.Diffuse varioliform gastritis is an uncommon form of gastric mucosal inflammation, the incidence in this unit being approximately 0.5% of over 20 000 upper endoscopies. It is an inflammatory condition affecting mainly the body of the stomach, and consists of swollen, congested rugae and scattered erosions situated on discrete mucosal elevations. These 'varioliform' lesions are commonly seen in the antrum, but diffuse varioliform gastritis should only be diagnosed when the mucosa of the fundus and body is affected, the rugae are enlarged, and consistent histological abnormalities are found. Synonyms of this condition include 'octopus sucker gastritis" and gastritis with complete erosions.2In a review of 90 cases seen in Lyon over a period of eight years,3 the clinical features were as follows: epigastric pain (70%, simulating peptic ulcer in 30%), anorexia and nausea with occasional vomiting (31%), weight loss (>5 kg in 34%, >10 kg in 20%), anaemia due to occult blood loss (3.3%), and overt bleeding (3.3%). Oedema due to hypoproteinaemia,