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AIMS To examine the clinicopathological characteristics of granulomatous gastritis (GG) among different aetiologies, particularly Crohn disease (CD), and determine the contribution of Helicobacter pylori and the clinical significance of isolated GG. METHODS AND RESULTS We identified 269 GG cases overall (0.19% prevalence): 220 had an underlying granulomatous disease (CD, sarcoidosis, tuberculosis) and only eight of these (3.6%) had H. pylori, fewer than the 10.3% rate among non-GG biopsies (P

Aims Studies investigating the relationship between granulomatous gastritis (GG) and Helicobacter pylori infection have been largely inconclusive. This study was designed to determine whether the analysis of a very large number of patients would provide clearer answers evaluate the association between H. pylori infection and gastric granulomas. Methods We used a large national database of clinicopathological data to extract 1,673,086 patients who underwent esophagogastroduodenoscopy with gastric biopsies between 2008 and 2020. In a case-control study, we evaluated the occurrence of H. pylori infection in patients with and without gastric granulomas. We also explored other clinical and histopathological associations. Results H. pylori infection was present in 44 of 496 (8.9%) patients with gastric granulomas, compared to 158,949 (9.5%) in the control group (OR = 0.93, 95% CI = 0.68-1.26). Of the 129 patients with gastric granulomas, 50 had documented inflammatory bowel disease. Conclusions The results of this study show that the prevalence of H. pylori infection in patients with gastric granulomas is essentially identical to that of controls with no evidence of granulomas or granulomatous disease. When patients with and without a plausible-known association for gastric granulomas were analyzed separately, the prevalence of H. pylori infection remained remarkably similar in GG patients and controls. Considering the very large numbers of patients with gastric biopsies analyzed in this study, we submit that there is no basis for suggesting that H. pylori is etiologically related to GG.

Introduction: Granulomas in gastric biopsy specimens are extremely rare. The final diagnosis of granulomatous gastritis is based on morphological findings, clinical and laboratory data. The aim of our study is to evaluate the clinical fields and to determine the etiology of gastric granulomatosis in our experience Patients and Methods: Thirty nine patients were reviewed retrospectively in the department of pathology of Habib Thameur between 2000 and 2018. Slides from all cases were stained by hematoxylin and eosin. The clinic-pathologic findings and the associated lesions were analyzed and the final etiology of the gastric granulomatosis was noted. Results: Biopsies from the 39 patients diagnosed as having granulomatous gastritis were reviewed. Mean age was 49 years (24 – 96) and sex ratio was 0,25 (M/F=8/31). Indication of endoscopy was gastric pain in 12 cases, chronic diarrhea in 6 cases, anemia in 2 cases, vomiting in 4 cases. Other symptoms were rare. Upper endoscopy was normal in 8 cases, showed antral gastropathy in 20 cases (erythematous in 6 cases, nodular in 8 cases and ulcerated in 6 cases). In four cases, fundic lesions were observed. Granuloma was unique in 14 cases and multiple in 25 cases. Localisation of granuloma was the antrum in 25 cases, the fundus in 7 cases, and both of them in 7 cases. An associated chronic gastritis was noted in 25 cases. Concerning the etiology, 10 of our patients had Crohn's disease while 6 of them had gastric tuberculosis. In five cases, H Pylori was the retained cause of gastric granulomatosis. In the other patients, the final diagnosis was sarcoidosis (n=3), foreign body reaction (n=1), yersiniosis (n=1). In our series, thirteen cases were unclassifiable. Conclusion: Although many cases remain unclassified, in most cases of granulomatous gastritis, a diagnosis of Crohn's disease or tuberculosis could be established. If this cases are excluded, an association between H. pylori and granulomatous gastritis cannot be ruled out. The others causes are extremely rare.

This chapter reviews the key clinical and histological findings of the most common forms of gastritis, focusing on diagnostically relevant questions for reactive gastropathy, peptic disease, Helicobacter pylori (H. pylori) gastritis, and autoimmune gastritis. In addition the key histological findings are discussed for rare forms of gastritis including lymphocytic gastritis, collagenous gastritis, granulomatous gastritis, eosinophilic gastritis, Sarcina gastritis, autoimmune atrophic pangastritis, idiopathic chronic gastritis, and Menetrier disease.

Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. However, some rare gastric lesions exhibiting distinctive histological features may also be associated with H. pylori infection, including lymphocytic gastritis, granulomatous gastritis, Russell body gastritis, or crystal-storing histiocytosis. Although diverse factors can contribute to their development, there is convincing evidence that H. pylori infection may play a pathogenic role. These findings are mainly based on studies in patients with these lesions who exhibited clinical and histological improvements after H. pylori eradication therapy. Thus, H. pylori eradication therapy might be indicated in patients with no other underlying disease, particularly in countries with a high prevalence of H. pylori infection. This review describes the characteristic histological features of these rare lesions and evaluates the evidence regarding a causative role for H. pylori infection in their pathogenesis.

Granulomas are rarely seen in gastric biopsies mostly as an involvement of granulomatous diseases like sarcoidosis, Crohn’s disease, infections, neoplasms, and vasculitis. Here, we claim cyanoacrylate as a foreign body type granuloma-causing agent in the stomach after vascular embolisation. We present cyanoacrylate associated gastric changes of three cases: two endoscopic biopsies and one gastric resection. In two cases, cyanoacrylate associated ulcers and granulomatous inflammation were observed in gastric mucosal biopsies following endoscopic examination after 7 months and 6 years of the glue injections, respectively. In the third case, the cyanoacrylate injection was performed 2 months prior to the surgery. Then the patient underwent distal pancreatectomy for pancreatic adenocarcinoma and during the operation a gastric mass was resected with a suspicion of tumoral infiltration. These three cases demonstrated that glue exposure causes active chronic inflammation with foreign body type granulomas, mucosal ulceration, and bleeding in the gastric mucosa. Even further, it can induce mass formation in the injection sites.

Some unique forms of gastritis and other rare forms of gastric injury can be seen in routine clinical practice. Among these, the most commonly encountered conditions are lymphocytic and collagenous gastritis, and graft versus host disease. These clinical entities as well as other less common conditions such as eosinophilic gastritis, granulomatous gastritis, focally enhanced gastritis, and some hypertrophic gastropathies are discussed in detail. This chapter describes clinical and endoscopic features, as well as key histopathological and immunohistochemical findings of these specific forms of gastritis. Pertinent differential diagnoses are listed along with key differentiating features.

Discus (Symphysodon spp.) are costly and prized specimens in the international ornamental fish trade. The majority of discus submitted to the Aquatic Animal Health Unit at the University of the West Indies School of Veterinary Medicine for necropsy between September 2010 and September 2015 had lesions consistent with Cryptobia iubilans infection, thus prompting this study. To determine the prevalence of the flagellated gastrointestinal protozoan C. iubilans in discus fish, 32 discus were sourced from 10 suppliers, including breeders, importers, and hobbyists across Trinidad. Fish were euthanized, and the internal organs, particularly the stomach and intestine, were observed under a light microscope for characteristic granulomatous lesions and/or live C. iubilans parasites. All wet-mount slides on which granulomas were observed were also Ziehl-Neelsen acid-fast stained to presumptively exclude the presence of Mycobacterium spp., the main differential when diagnosing C. iubilans-associated granulomatous gastritis or to determine the presence of dual infections. Further histological analyses were performed on stomach and intestinal sections, and transmission electron microscopy was used to confirm the parasite in stomach sections. The prevalence of C. iubilans infection was found to be 81.3%, and the prevalence of presumptive dual infections with Mycobacterium spp. was found to be 21.9%. To the best of our knowledge, this is the first documented study of C. iubilans infections in the wider Caribbean region.

A 6- month -old male mongrel dog was presented with clinical signs of vomiting, anorexia, weakness and chronic weight loss. At necropsy, an ulcerated granuloma containing numerous nematodes was found in the fundus of the stomach. Several worms were also noted in the gastric lumen. Histologically, there was a granulomatous gastritis with intralesional nematodes characteristic of Gnathostoma spinigerum. This is the first report of gnathostomiasis in a dog in Zambia.

Granulomatous gastritis is a condition which may occur in association with Crohn’s disease, sarcoidosis, Wegener’s granulomatosis, tuberculosis, foreign body reaction or certain drugs including cocaine. Here, we report a diagnosis of granulomatous gastritis in a sarcoidosis patient who presented with non-specifi c dyspeptic complaints.

A 64-year-old man presented with gradual onset of confusion, ataxia and 25-pound weight loss over 3 months. MRI of the brain revealed two enhancing cerebellar lesions suspicious for metastases. Positron emission tomography-CT showed enhancement of cervical and axillary lymph nodes. Left axillary lymph node biopsy showed no evidence of malignancy but instead showed fungal organisms morphologically consistent with Histoplasma spp. Disseminated histoplasmosis with central nervous system involvement was suspected. Further history revealed that the patient had been having subjective fever for the past several months. He has had mild pancytopenia for about 2 years, which had not been further evaluated. Additionally, he had an oesophagogastroduodenoscopy 3 months prior to admission, which had shown granulomatous gastritis. Subsequently, the diagnosis of disseminated histoplasmosis was confirmed by serological testing and bone marrow biopsy. The patient was started on liposomal amphotericin B. Unfortunately, the patient had a catastrophic stroke and was transitioned to comfort care measures.

Stranded cetaceans are often found with gastric lesions associated with the presence of parasites; most frequently, nematodes of the genus Anisakis and the heterophyd digenean trematode Pholeter gastrophilus. In this study, we present histopathology mainly (but not exclusively) related to these 2 parasite species. Macroscopically, lesions associated with the presence of Anisakis spp. were characterised by the presence of ulcers within the gastric mucosa, while the digenean P. gastrophilus was found within large submucosal fibrotic nodules in the gastric wall. Anisakis-induced alterations included severe ulcerative gastritis with mixed inflammatory infiltrate often associated with colonies of bacteria, and mild to moderate granulomatous gastritis with eosinophilic infiltrate. P. gastrophilus-associated lesions were characterised by fibrogranulomatous gastritis with mixed inflammatory infiltrate. Additionally, immunohistochemical (IHC) analysis of P. gastrophilus lesions was consistent with the histopathologic findings, revealing inflammation-mediated stimulation. IHC-positive localisation of CD3+, iNOS+ and caspase-3+ cells suggests intensive accumulation of cytotoxic T-cells, proinflammatory cytokines and execution-phase of cell apoptosis at the parasitized area. In contrast, mechanical damage, rather than visible inflammatory response could be observed at the site of attachment of Braunina cordiformis recorded in 4 animals. Lesions not associated with the presence of parasites were mostly characterised by focal loss of superficial epithelial cells and accumulation of brown hemosiderin-like pigment or fibrous gastritis with lymphoplasmacytic infiltrate. In light of these results, we argue that observed 'tolerant' host-parasite interactions that led toward gastric lesions do not represent the cause of death and stranding of cetaceans included in this study.

The chapter describes the histological features of the normal mucosa in the four main regions of the stomach: the cardia, fundus, body, and antrum. It also addresses the main histological changes seen in the most commonly seen gastritis: Helicobacter pylori gastritis, lymphocytic gastritis, granulomatous gastritis and gastric Crohn’s disease, eosinophilic gastritis, graft-versus-host disease, reactive gastropathy, and nonspecific gastritis.

Sarcoidosis is a multisystem disease of unknown etiology, characterized by specific granulomas without caseous necrosis in the affected organs and tissues. Along with respiratory organs, the gastrointestinal tract may be affected by sarcoidosis. Due to the rarity of gastric involvement of sarcoidosis, substantial difficulties arise in verifying the diagnosis, making a differential diagnosis, and examining gastric biopsy specimens. The paper describes in detail pathological changes in the gastric wall tissue specimen in sarcoidosis and comparatively analyzes the findings with the data available in the literature.Саркоидоз - мультисистемное заболевание неизвестной этиологии, характеризующееся появлением специфических гранулем без казеозного некроза в пораженных органах и тканях. Наряду с органами дыхания при саркоидозе может поражаться желудочно-кишечный тракт. В связи с редкостью поражения желудка при саркоидозе возникают существенные трудности при верификации диагноза, проведении дифференциальной диагностики и исследовании гастробиоптатов. В статье приведено подробное описание патологических изменений в гистологическом препарате стенки желудка при саркоидозе, а также проведен сравнительный анализ полученных данных с имеющимися сведениями в литературе.

A 71-year-old man in whom a gastric submucosal lesion was found incidentally was referred to our hospital for detailed examination. Esophagastroduodenoscopy showed a submucosal lesion in the body of the stomach. Endoscopic ultrasound revealed a 15-mm hypoechoic round mass with calcifications arising from the muscular layer. Confusing the diagnosis, it resembled a gastrointestinal mesenchymal tumor. Subsequently, endoscopic ultrasound-guided fine-needle aspiration was conducted for definitive diagnosis. Pathologic analysis showed a granuloma. Because this patient had no prior exposure to tuberculosis or Helicobacter pylori infection and had no abnormal laboratory data, this submucosal lesion was diagnosed as idiopathic granulomatous gastritis.

Crohn's disease is usually associated with intestinal disease when it affects the stomach. It is the most common cause of granulomatous gastritis; however, isolated gastric Crohn's disease is an uncommon finding. This is a case report of a 26-year-old woman who presented with intermittent epigastric pain for 2 years and severe weight loss during the course of her illness. Paraclinical investigations ruled out the possibility of malignancy; further investigations revealed a short segment of focal thickening in the gastric antrum. However, small and large bowels were normal on abdominal computed tomography and severe form of hemorrhagic gastritis on upper gastrointestinal endoscopy. Multiple gastric biopsies obtained from the stomach were consistent with the diagnosis of Crohn's disease. Treatment with prednisolone and azathioprine was effective in controlling the patient's symptoms; however, these recurred 3 weeks after she interrupted therapy. Treatment was resumed with the same drugs, and she was symptom-free over the18 months during which she was followed up. This case demonstrates the role of gastric biopsy as an important investigation in establishing the diagnosis of this rare presentation. It also reflects the dramatic response of gastric Crohn's disease to the treatment with prednisolone and azathioprine.

Since the discovery of Helicobacter pylori in 1982, the development of several treatment guidelines has allowed a consensus on the indications for H. pylori eradication. Beyond these currently accepted indications, including various upper gastrointestinal disorders and extragastric diseases, a significant amount of new information regarding H. pylori eradication is emerging. Certain types of acute gastritis, such as nodular gastritis, hypertrophic gastritis, Menetrier's disease, hemorrhagic gastritis, and granulomatous gastritis are reversible after H. pylori eradication. Further, for chronic gastritis, closed-type atrophic gastritis and complete-type intestinal metaplasia appear to be more reversible after H. pylori eradication than open-type atrophic gastritis and incomplete-type intestinal metaplasia. Eradication can also be considered in subjects younger than 40 years who have a family history of gastric cancer and in subjects with long-term medications that might lead to bleeding (antiplatelet agents) or atrophy (proton pump inhibitors). Emerging evidence indicates that H. pylori eradication could be an effective treatment for some extragastric diseases that are unresponsive to conventional therapy. In such conditions, routine screening for eradication of H. pylori has not previously been recommended; a "test-and-treat" approach is suggested in the aforementioned situations. Given that H. pylori eradication is effective when the gastritis is reversible, future indications should be expanded to include acute gastric lesions that show marked improvement upon H. pylori eradication rather than just focusing on chronic gastric lesions. Future indications for H. pylori eradication should focus more on reversible lesions before preneoplastic conditions develop.

A 41-year-old female presented with a 2 cm gastric submucosal tumor that was suspected to be a gastrointestinal stromal tumor or other malignancy, and local resection of the stomach was performed. However, histopathological examination showed granulomatous gastritis (GG) with a variety of chronic inflammatory cells and multinodular granulomas. Although she had a past history of tuberculosis and advanced breast cancer after surgery, there was no apparent evidence of either tuberculosis or a metastatic tumor. Other causes of GG, such as mycosis, syphilis, sarcoidosis or foreign body reaction were also excluded. There were no clinical features of Crohn's disease as the principal differential diagnosis. Therefore, she was diagnosed to have idiopathic granulomatous gastritis (IGG). IGG is rare with few reports, and this report presents a surgical case of IGG resembling a gastrointestinal stromal tumor.

This is a report of lesions associated with the nematode Contracaecum rudolphii (Nematoda: Anisakidae) from the proventriculus of the great cormorant, Phalacrocorax carbo (L. 1758). The study was undertaken as part of a health monitoring program for P. carbo, which is endangered and thus protected within the European continent. Cormorants were collected by gun-shot from north-eastern Poland in the spring of 2006, four birds were necropsied on site and the gastrointestinal tract was examined for the presence of nematodes. The birds came from a region with noted increases in the cormorant population over the last decade. Esophageal and gastric sections with parasites in situ were fixed in formalin and processed routinely for paraffin embedding, stained with H&E and examined by brightfield microscopy. Parasite associated lesions consisted of severe, ulcerative gastritis at the attachment sites, and diffuse granulomatous gastritis in adjacent areas. Eosinophilic material speculated to be the parasite-derived excretory-secretory product was consistently forming the parasite-host boundry at the attachment points. Although the parasite-associated gastric lesions were focally severe, all examined birds appeared in good body condition. Because only four birds were investigated in this study, the potential contribution of C. rudolphii to morbidity and mortality in great cormorants needs to be examined further.

We describe lesions associated with a seemingly intense infection of trypanorhynch plerocerci (Platyhelminthes: Cestoda: Trypanorhyncha) in the gastric wall of a female cownose ray, Rhinoptera bonasus (Myliobatiformes: Rhinopteridae) captured in the northern Gulf of Mexico. Grossly, the multitude of encapsulated, encysted plerocerci imparted a bumpy and cobbled appearance to the serosa of the stomach, and none was observed in any other tissue during routine parasitological necropsy. Histologically, the plerocerci were associated with severe intramural granulomatous gastritis, vascular ectasia and mesothelial polyposis with the exclusion of the mucosa. To our knowledge, this is the first published case study documenting platyhelminth-associated histopathological changes in the gastrointestinal tract of R. bonasus as well as that of the efficacy of immunocytochemical markers for smooth muscle actin, Factor VIII, S-100, and proliferating cell nuclear antigen in Myliobatiformes. It also may serve as a potential primer for much needed ecological investigations regarding the potential role of elasmobranchs as intermediate or ‘paratenic' hosts in the life cycles of trypanorhynch cestodes.

Since its recognition as the causative agent for most cases of gastritis, the prevalence of Helicobacter pylori-induced gastritis has been declining, in part due to the deliberate and inadvertent use of various medications. As a result, pathologists find themselves facing cases of gastritis in which, based upon history and histology, there are expected but undetectable H. pylori organisms. This review explores the 2 possibilities of false-negative and true-negative gastritides, including when and how to search for H. pylori, explanations for absent organisms in cases of true H. pylori gastritis, and other causes of gastritis that may mimic H. pylori infection. The latter group includes reactive gastropathy with focal activity, focally active gastritis and carditis, autoimmune gastritis, granulomatous gastritis, lymphocytic gastritis, and other infections.

A 46-year-old man had chronic granulomatous gastritis characterized by giant gastric folds with noncaseating epithelioid granulomas including giant cells in the corpus. No definite etiologic factors were detected. Histology and the rapid urease test indicated that H. pylori was present in both the antrum and corpus. The granulomatous gastritis with giant gastric folds improved after H. pylori eradication. This case suggests an association between isolated granulomatous gastritis and H. pylori infection.

症例は73歳，女性．肋骨骨折で2006年2月入院．入院中に上腹部痛を自覚し，内視鏡施行したが異常なし．退院後より下痢出現．食思不振も伴い3月外来受診．腹部全体に圧痛を認め，血液検査で高度の炎症反応を認め緊急入院．入院4日後，突然吐血し，意識消失，血圧触知不能，ショック状態となり，直ちに緊急内視鏡施行．胃内は新鮮血が充満しており，多発性アフタ性潰瘍を認めたが出血源は不明．内視鏡施行中，輸血するも循環動態保てず，内視鏡による止血は困難と判断し緊急手術となった．術中所見では胃の漿膜面に異常を認めず，胃全摘術施行．切除標本では胃の全域に多発する浅い潰瘍を認めた．病理所見は潰瘍辺縁，粘膜固有層に小型肉芽腫が散在し，H. pylori陽性であった．サルコイドーシス，Crohn病，結核や梅毒などの感染症，腫瘍による肉芽腫は否定的であり，特発性肉芽腫性胃炎と診断した．術後経過は良好であった．

Isolated or idiopathic granulomatous gastritis (IGG) is a rare disease and its etiology remains unclear. Some recent papers have reported that IGG is caused by Helicobacter pylori. We present herein a case of IGG that resolved spontaneously without H. pylori eradication. A 54-year-old woman displayed rigidity and thickened folds in the gastric corpus on upper gastrointestinal series. Upper gastrointestinal endoscopy revealed erythematic mucosa and thickened folds. Biopsies of gastric mucosa taken via endoscopy showed noncaseating granulomas and H. pylori infection. The patient was diagnosed with IGG, as no causes of granuloma (e.g., Crohn's disease, sarcoidosis, foreign bodies), excluding H. pylori were identified. Since this patient did not have any symptoms, she was followed without medication, including for eradication of H. pylori. Rigidity and thickened folds normalized with 6 months. Although H. pylori is suspected as the cause of IGG, this case resolved without H. pylori eradication. We thus conclude that the cause of IGG is not H. pylori alone.

Granulomas in gastric biopsy specimens are extremely rare, and in Western countries, more than half are associated with Crohn's disease. To evaluate the incidence and their etiology in a gastric carcinoma (and Helicobater pylori infection)-prevalent area, gastric mucosal biopsies were reviewed and their clinicopathologic findings were analyzed. The clinicopathologic diagnoses of the 18 patients with granulomatous gastritis were as follows: chronic gastritis with (n = 14) and without (n = 1) H. pylori infection; gastric adenocarcinomas (n = 2); and Crohn's disease (n = 1). Almost all cases of granulomatous gastritis in this study showed small erosions or ulcers on the endoscopic examinations. H. pylori were found to be one of the most common causes of granulomatous gastritis after excluding all other causes for the granulomas in this study. The granulomas were more frequently found in the antrum, superficially located, and were related to damage within a pit in which the H. pylori were commonly observed. These findings suggest that H. pylori can be causal in the pathogenesis of granulomatous gastritis.

Aims We describe the fourth reported case of granulomatous gastritis associated with gastric adenocarcinoma, with a review of the literature and considerations about the prognostic implications of this association. Results A 48-year-old woman who had been suffering from gastritis for ten years was admitted to our institute for increasing left epigastric pain associated with vomiting. After an endoscopic biopsy had revealed an ulcerated signet ring cell carcinoma, the patient was submitted to subtotal gastrectomy with regional lymph node dissection. Pathological examination of the resected specimen revealed a superficial signet ring cell carcinoma (early cancer) associated with multiple granulomas. The granulomas, which were observed within the mucosa and the submucosa at the periphery of the carcinoma, were composed of CD68-positive, CD15-negative epithelioid and giant cells of the Langhans type, confirming their true histiocytic nature, and were also extensively found within the dissected lymph nodes. Since no ocular, skin, pulmonary or other gastrointestinal lesions were found and the granulomas were negative for acid-fast and fungal stain, a diagnosis of granulomatous gastritis was made. Conclusions To the best of our knowledge this is the fourth example of gastric adenocarcinoma and granulomatous gastritis. These cases suggest an association between granulomatous gastritis and early gastric cancer.

We present a case of isolated granulomatous gastritis in a 21-year-old woman. Initial symptoms included nausea, vomiting and inability to tolerate oral intake. An upper oesophagogastroduodenoscopy revealed nodular and thickened mucosa with histological findings of granulomatous gastritis. Infectious, inflammatory and malignant causes were excluded prior to making a diagnosis of gastric sarcoidosis.

Distinctive gastritis refers to gastritis with distinctive histological and endoscopic features, including the presence of granulomas, the increased number of intraepithelial lymphocytes, eosinophilic infiltration, thickening of the subepithelial collagen band, and foveolar hyperplasia. Several forms of distinctive gasatritis are reviewed in this issue, since understanding of its pathogenesis and the accurate diagnosis are implicated in clinical prognostic biomarkers and lead to a new therapeutic approach., Acta medica Nagasakiensia. 2001, 46(1-2), p.9-14

Granulomatous gastritis is a rarely observed pathological diagnosis. This condition often mimics gastric adenocarcinoma clinically, resulting in gastric resection. However, granulomatous gastritis has long been viewed as a benign process not observed in association with adenocarcinoma of the stomach. This article describes a patient with granulomatous gastritis occurring in close proximity to an area of superficially invading gastric adenocarcinoma.Acid-fast stains, fungal stains, standard cultures, tuberculosis cultures, and a VDRL serum test were all obtained. Both upper endoscopy and colonoscopy were performed. Chest radiographs were taken and pulmonary consultation was obtained.The gastric samples obtained from resection showed no evidence of foreign body reaction. The acid-fast stains, fungal stains, cultures, and VDRL were all negative. Endoscopic exams did not show granulomatous inflammation in any other part of the gastrointestinal tract. No pulmonary disease was evident on radiographic or pulmonary exam.Isolated granulomatous gastritis is a diagnosis of exclusion. The findings in this patient do not support a diagnosis of Crohn's disease, tuberculosis, sarcoidosis, syphilis, histoplasmosis, berylliosis, or foreign-body reaction. This is a unique case suggesting an association between isolated granulomatous gastritis and metaplastic mucosal changes.