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.

Intracellular immunofluorescence staining was used to identify lymphoid cells from human gastric mucosa. Staining of serial sections for each of the five classes of immunoglobulin-containing cells revealed the presence of all classes. Their relative frequencies in the antral mucosae of 30 patients with bile reflux gastritis were 51% IgA, 16% IgM, 18.5% IgG, 2.5% IgD and 12% IgE. The mucosae of 15 control subjects showed 75% IgA, 8% IgM, 15% IgG, 1%IgD and 1% IgE and the mucosae of 30 patients with inflammatory gastritis without bile reflux revealed 67% IgA, 6.5% IgM, 22.5% IgG, 1.5% IgD and 2.5% IgE. These features suggest that allergy participates in the physiopathology of bile reflux gastritis.

A historical series of varioliform gastritis published in 1978 by Lambert et al. (Digestion 1978; 17: 159-167) was revisited by two pathologists. The histological preparations from 35 patients were reread and interpreted in the light of endoscopic data found in the files. The results demonstrate a strict correlation between clinical diffuse varioliform gastritis and a recently recognized histopathological entity--lymphocytic gastritis, which is characterized by intense lymphocytic infiltration of the surface and foveolar epithelium. The rare discrepancies occur in Crohn's disease and in varioliform gastritis limited to part of the stomach, mostly the antrum.