Gastritis, Chronic

Introduction
Background

Chronic gastritis is a histopathologic entity characterized by chronic inflammation of the stomach mucosa. Gastritides can be classified based on the underlying etiologic agent (eg, Helicobacter pylori, bile reflux, nonsteroidal anti-inflammatory drugs [NSAIDs], autoimmunity, allergic response) and the histopathologic pattern, which may suggest the etiologic agent and clinical course (eg, H pylori –associated multifocal atrophic gastritis). The image below depicts chronic active gastritis caused by H pylori.


Helicobacter pylori-caused chronic active gastritis. Genta stain (20X). Multiple organisms (brown) are visibly adherent to gastric surface epithelial cells.

Other classifications are based on the endoscopic appearance of the gastric mucosa (eg, varioliform gastritis). Although minimal inflammation is observed in some gastropathies, such as those associated with NSAID intake, these entities are discussed in this article because they are frequently included in the differential diagnosis of chronic gastritis.

Chemical or reactive gastritis is caused by injury of the gastric mucosa by reflux of bile and pancreatic secretions into the stomach, but it can also be caused by exogenous substances, including NSAIDs, acetylsalicylic acid, chemotherapeutic agents, and alcohol.1 These chemicals cause epithelial damage, erosions, and ulcers that are followed by regenerative hyperplasia detectable as foveolar hyperplasia, and damage to capillaries, with mucosal edema, hemorrhage, and increased smooth muscle in the lamina propria.

Inflammation in these lesions caused by chemicals is minimal or lacking; therefore, the term gastropathy or chemical gastropathy is more appropriate to describe these lesions than is the term chemical or reactive gastritis as proposed by the updated Sydney classification of gastritis.2 Importantly, mixed forms of gastropathy and other types of gastritis, especially H pylori gastritis, may coexist.

No single classification of gastritis provides an entirely satisfactory description of all types of gastritis.3 However, an etiologic classification provides a direct target toward which therapy can be directed, and, for this reason, the etiologic classification is used in this article. In many instances, chronic gastritis is a relatively minor manifestation of diseases that predominantly manifest in other organs or manifest systemically, such as gastritis in individuals who are immunosuppressed.

Helicobacter gastritis is a primary infection of the stomach and is the most frequent cause of chronic gastritis. Cases of histologically documented chronic gastritis are diagnosed as chronic gastritis of undetermined etiology or gastritis of undetermined type when none of the findings reflect any of the described patterns of gastritis and a specific cause cannot be identified.

Pathophysiology

The pathophysiology of chronic gastritis complicating a systemic disease, such as hepatic cirrhosis, uremia, or another infection, is described in the relevant disease articles. The pathogenesis of the most common forms of gastritis is described as follows.

H pylori- associated chronic gastritis

H pylori are gram-negative rods that have the ability to colonize and infect the stomach. The bacteria survive within the mucous layer that covers the gastric surface epithelium and the upper portions of the gastric foveolae. The infection is usually acquired during childhood. Once the organism has been acquired, has passed through the mucous layer, and has become established at the luminal surface of the stomach, an intense inflammatory response of the underlying tissue develops.4

The presence of H pylori is associated with tissue damage and the histologic finding of both an active and chronic gastritis. The host response to H pylori and bacterial products is composed of T- and B-cell lymphocytes, denoting chronic gastritis, followed by infiltration of the lamina propria and gastric epithelium by polymorphonuclear leukocytes that eventually phagocytize the bacteria. The presence of polymorphonuclear leukocytes in the gastric mucosa is diagnostic of active gastritis.

The interaction of H pylori with the surface mucosa results in the release of proinflammatory cytokine interleukin (IL)-8, which leads to recruitment of polymorphonuclear cells and may begin the entire inflammatory process. Gastric epithelial cells express class II molecules, which may increase the inflammatory response by presenting H pylori antigens, leading to further cytokine release and more inflammation. High levels of cytokines, particularly tumor necrosis factor-a (TNF-α)5 and multiple interleukins (eg, IL-6, IL-8, IL-10), are detected in the gastric mucosa of patients with H pylori gastritis.

Leukotriene levels are also quite elevated, especially leukotriene B4, which is synthesized by host neutrophils and is cytotoxic to gastric epithelium. This inflammatory response leads to functional changes in the stomach, depending on the areas of the stomach involved. When inflammation affects the gastric corpus, parietal cells are inhibited, leading to reduced acid secretion. Continued inflammation results in loss of parietal cells, and the reduction in acid secretion becomes permanent.

Antral inflammation alters the interplay between gastrin and somatostatin secretion, affecting G cells (gastrin-secreting cells) and D cells (somatostatin-secreting cells), respectively. Specifically, gastrin secretion is abnormal in individuals who are infected with H pylori, with an exaggerated meal-stimulated release of gastrin being the most prominent abnormality. When the infection is cured, neutrophil infiltration of the tissue quickly resolves, with slower resolution of the chronic inflammatory cells. Paralleling the slow resolution of the monocytic infiltrates, meal-stimulated gastrin secretion returns to normal.

Differences in virulence factors that characterize different strains of H pylori influence the clinical outcome of H pylori infection. People infected with H pylori strains that secrete the vacuolating toxin A (vacA) are more likely to develop peptic ulcers than people infected with strains that do not secrete this toxin. Another set of virulence factors is encoded by the H pylori pathogenicity island (PAI). The PAI contains the sequence for several genes and encodes the CAGA gene. Strains that produce CagA protein (CagA+) are associated with a greater risk of development of gastric carcinoma and peptic ulcers. However, infection with CagA- strains also predisposes the person to these diseases.6,7,8

H pylori- associated chronic gastritis progresses with the following 2 main topographic patterns that have different clinical consequences:
Antral predominant gastritis is characterized by inflammation and is mostly limited to the antrum. Individuals with peptic ulcers usually demonstrate this pattern of gastritis.
Multifocal atrophic gastritis is characterized by involvement of the corpus and gastric antrum with progressive development of gastric atrophy (loss of the gastric glands) and partial replacement of gastric glands by an intestinal-type epithelium (intestinal metaplasia). Individuals who develop gastric carcinoma and gastric ulcers usually demonstrate this pattern of gastritis.

Most of the people who are infected with H pylori do not develop significant clinical complications, and they remain carriers with asymptomatic chronic gastritis. Some individuals who carry additional risk factors may develop peptic ulcers, gastric mucosa–associated lymphoid tissue (MALT) lymphomas, or gastric adenocarcinomas.

An increased duodenal acid load may precipitate and wash out bile salts, which normally inhibit the growth of H pylori. Progressive damage to the duodenum promotes gastric foveolar metaplasia, resulting in sites for H pylori growth and more inflammation. This cycle results in the increasing inability of the duodenal bulb to neutralize acid entering from the stomach until changes in duodenal bulb structure and function are sufficient for an ulcer to develop. H pylori can survive in areas of gastric metaplasia in the duodenum, contributing to the development of peptic ulcers.

MALT lymphomas may develop in association with chronic gastritis secondary to H pylori infection. The healthy stomach lacks organized lymphoid tissue, but, following infection with H pylori, lymphoid tissue is universally present. Acquisition of gastric lymphoid tissue is thought to be due to persistent antigen stimulation from byproducts of chronic infection with H pylori. The continuous presence of H pylori results in the persistence of MALT in the gastric mucosa, which eventually may progress to form low- and high-grade MALT lymphomas. MALT lymphomas are monoclonal proliferations of neoplastic B cells that have the ability to infiltrate gastric glands. Gastric MALT lymphomas typically are low-grade T-cell–dependent B-cell lymphomas, and the antigenic stimulus of gastric MALT lymphomas is thought to be H pylori.

Another complication of H pylori gastritis is the development of gastric carcinomas, especially in individuals who develop extensive atrophy and intestinal metaplasia of the gastric mucosa. Although the relationship between H pylori and gastritis is constant, only a small proportion of individuals infected with H pylori develop gastric cancer. The incidence of gastric cancer usually parallels the incidence of H pylori infection in countries with a high incidence of gastric cancer and is consistent with H pylori being the cause of the precursor lesion, chronic atrophic gastritis.

Persistence of the organisms and associated inflammation during long-standing infection is likely to permit the accumulation of mutations in the gastric epithelial cells' genome, leading to an increased risk of malignant transformation and progression to adenocarcinoma. Studies have provided evidence of the accumulation of mutations in the gastric epithelium secondary to oxidative DNA damage associated with chronic inflammatory byproducts and secondary to deficiency of DNA repair induced by chronic bacterial infection.

Although the role of H pylori in peptic ulcer disease is well established, the clinical role of the infection in nonulcer dyspepsia remains very controversial. H pylori eradication may be beneficial for symptom relief in a small proportion of patients, but routine H pylori testing and treatment in nonulcer dyspepsia is not currently widely accepted. Therefore, consider H pylori eradication strategies in patients with nonulcer dyspepsia on an individual patient-by-patient basis.

Infectious granulomatous gastritis

Granulomatous gastritis (see image below) is a rare entity. Tuberculosis may affect the stomach and cause caseating granulomas. Fungi can also cause caseating granulomas and necrosis, a finding that is usually observed in patients who are immunosuppressed.


Granulomatous chronic gastritis. Noncaseating granulomas in the lamina propria. Courtesy of Sydney Finkelstein, MD, PhD, University of Pittsburgh.

Gastritis in patients who are immunosuppressed


Cytomegalovirus (CMV) infection of the stomach is observed in patients with underlying immunosuppression. Histologically, typical intranuclear eosinophilic inclusions and, occasionally, smaller intracytoplasmic inclusions are found (see image below).


Chronic gastritis. Typical cytomegalovirus inclusions in lamina propria capillary endothelial cells. Courtesy of Sydney Finkelstein, MD, PhD, University of Pittsburgh.

A patchy, mild inflammatory infiltrate is observed in the lamina propria. Viral inclusions are present in gastric epithelial cells and in endothelial or mesenchymal cells in the lamina propria. Severe necrosis may result in ulceration. Herpes simplex causes basophilic intranuclear inclusions in epithelial cells. Mycobacterial infections by Mycobacterium avium-intracellulare are characterized by diffuse infiltration of the lamina propria by histiocytes, which rarely form granulomas (see image below).


Chronic gastritis. Mycobacterium avium-intracellulare in gastric lamina propria macrophages. Courtesy of Sydney Finkelstein, MD, PhD, University of Pittsburgh.

Autoimmune gastritis

This type of gastritis is associated with serum antiparietal and anti-intrinsic factor (IF) antibodies. The gastric corpus undergoes progressive atrophy, IF deficiency occurs, and patients may develop pernicious anemia.

The development of chronic atrophic gastritis limited to corpus-fundus mucosa and marked diffuse atrophy of parietal and chief cells characterize autoimmune atrophic gastritis. Autoimmune gastritis is associated with serum antiparietal and anti-IF antibodies that cause IF deficiency, which, in turn, causes decreased availability of cobalamin and, eventually, pernicious anemia in some patients.

Autoantibodies are directed against at least 3 antigens, including IF, cytoplasmic (microsomal-canalicular), and plasma membrane antigens. Two types of IF antibodies are detected (ie, types I and II). Type I IF antibodies block the IF-cobalamin binding site, thus preventing the uptake of vitamin B-12. Cell-mediated immunity also contributes to the disease. T-cell lymphocytes infiltrate the gastric mucosa and contribute to epithelial cell destruction and resulting gastric atrophy. A recent study reported that gender, age, vitamin B12, folate, renal function, atrophic gastritis and the methylenetetrahydrofolate (MTHF) 677TT genotype were significant determinants of homocysteine levels, which were positively related to incident cardiovascular diseases.9

Chronic reactive chemical gastropathy

This type of gastritis is associated with long-term intake of aspirin or NSAIDs. It also develops when bile-containing intestinal contents reflux into the stomach. Although bile reflux may occur in the intact stomach, most of the features associated with bile reflux are typically found in patients with partial gastrectomy, in whom the lesions develop near the surgical stoma. The mechanisms through which bile alters the gastric epithelium involve the effect of several bile constituents. Both lysolecithin and bile acids can disrupt the gastric mucous barrier, allowing the back diffusion of positive hydrogen ions and resulting in cellular injury. Pancreatic juice enhances epithelial injury in addition to bile acids. In contrast to other chronic gastropathies, minimal inflammation of the gastric mucosa typically occurs in chemical gastropathy.

Chronic noninfectious granulomatous gastritis

Noninfectious diseases are the usual cause of gastric granulomas and include Crohn disease, sarcoidosis, and isolated granulomatous gastritis. Crohn disease demonstrates gastric involvement in approximately 33% of the cases. Granulomas have also been described in association with gastric malignancies, including carcinoma and malignant lymphoma. Sarcoidlike granulomas may be observed in people who use cocaine, and foreign material is occasionally observed in the granuloma.

Lymphocytic gastritis

This is a type of chronic gastritis with dense infiltration of the surface and foveolar epithelium by T lymphocytes and associated chronic infiltrates in the lamina propria. Because of similar histopathology relative to celiac disease, lymphocytic gastritis has been proposed to result from intraluminal antigens. High anti-H pylori antibody titers have been found in patients with lymphocytic gastritis, and, in limited studies, the inflammation disappeared after H pylori eradication. However, many patients with lymphocytic gastritis are serologically negative for H pylori. A number of cases may develop secondary to intolerance to gluten and drugs such as ticlopidine.

Eosinophilic gastritis

Large numbers of eosinophils may be observed with parasitic infections such as those caused by Eustoma rotundatum and anisakiasis. Eosinophilic gastritis can be part of the spectrum of eosinophilic gastroenteritis. Although the gastric antrum is commonly affected and can cause gastric outlet obstruction, this condition can affect any segment of the GI tract and can be segmental.10 Patients frequently have peripheral blood eosinophilia. In some cases, especially in children, eosinophilic gastroenteritis can result from food allergy, usually to milk or soy protein. Eosinophilic gastroenteritis can also be found in some patients with connective tissue disorders, including scleroderma, polymyositis, and dermatomyositis.

Radiation gastritis

Small doses of radiation (up to 1500 R) cause reversible mucosal damage, whereas higher radiation doses cause irreversible damage with atrophy and ischemic-related ulceration. Reversible changes consist of degenerative changes in epithelial cells and nonspecific chronic inflammatory infiltrate in the lamina propria. Higher amounts of radiation cause permanent mucosal damage, with atrophy of fundic glands, mucosal erosions, and capillary hemorrhage. Associated submucosal endarteritis results in mucosal ischemia and secondary ulcer development.

Ischemic gastritis

Ischemic gastritis is believed to result from atherosclerotic thrombi arising from the celiac and superior mesenteric arteries.

Frequency
United States

Approximately 35% of adults are infected with H pylori, but the prevalence of infection in minority groups and immigrants from developing countries is much higher. Children aged 2-8 years in developing nations acquire the infection at a rate of about 10% per year; whereas, in the United States, children become infected at a rate of less than 1% per year. This major difference in the rate of acquisition in childhood is responsible for the differences in epidemiology between developed countries and developing countries. Socioeconomic differences are the most important predictor of the prevalence of the infection in any group. Higher standards of living are associated with higher levels of education and better sanitation, thus the prevalence of infection is lower.

In the United States and in other countries with modern sanitation and clean water supplies, the rate of acquisition has been decreasing since 1950. The rate of infection in people with several generations of their families living at a high socioeconomic status is in the range of 10% to 15%. This is probably the lowest the prevalence can decline spontaneously until eradication or vaccination programs are instituted.

Lymphocytic gastritis has been estimated to represent approximately 1.4% of all gastritides. The disease has been reported in various parts of the world but more commonly in Europe, and it appears to be less common in the United States.

Chronic reactive chemical gastropathy is one of the most common and poorly recognized lesions of the stomach.
International

An estimated 50% of the world population is infected with H pylori; therefore, chronic gastritis is extremely frequent. H pylori infection is highly prevalent in Asia and in developing countries, and multifocal atrophic gastritis and gastric adenocarcinomas are more prevalent in these areas.11

Autoimmune gastritis is a relatively rare disease, most frequently observed in individuals of northern European descent1,12 and blacks. The prevalence of pernicious anemia, resulting from autoimmune gastritis, has been estimated at 127 cases per 100,000 members of the population in the United Kingdom, Denmark, and Sweden. The frequency of pernicious anemia is increased in patients with other immunologic diseases, including Graves disease, myxedema, thyroiditis, and hypoparathyroidism.
Mortality/Morbidity

Morbidity of chronic gastritis is strongly related to the underlying cause. Chronic gastritis as a primary disease, such as H pylori- associated chronic gastritis, may progress as an asymptomatic disease in some patients, whereas other patients may report dyspeptic symptoms.

The clinical course may be worsened when patients develop any of the possible complications of H pylori infection such as peptic ulcer or gastric malignancy.
H pylori gastritis is the most frequent cause of MALT lymphoma. Patients with chronic atrophic gastritis may have a 12- to 16-fold increased risk of developing gastric carcinoma, compared with the general population. Approximately 1 in 6 infected persons develop peptic ulcer, and, in the United States, approximately 25% develop hypochlorhydria or achlorhydria. The lifetime risk of gastric cancer is in the range of 1% to 3%.
Environmental factors, such as diet and standard of living, are important in determining which pathway is prevalent in a country or area.
In patients with autoimmune gastritis, the major effects are consequent to the loss of parietal and chief cells and include achlorhydria, hypergastrinemia, loss of pepsin and pepsinogen, anemia, and an increased risk of gastric neoplasms. Autoimmune gastritis represents the most frequent cause of pernicious anemia in temperate climates. The risk of gastric adenocarcinoma appears to be at least 2.9 times higher in patients with pernicious anemia than in the general population.

Race

H pylori -associated chronic gastritis appears to be more common among Asian and Hispanic people than in people of other races.

In the United States, H pylori infection is more common among black, Native American, and Hispanic people than among white people, a difference that has been attributed to socioeconomic factors.
Autoimmune gastritis is more frequent in individuals of northern European descent and in black people, and it is less frequent in southern European and Asian people.
Sarcoidosis is more frequent in young black people, whereas isolated granulomatous gastritis is more common in older white people.
Sex
Chronic H pylori- associated gastritis affects both sexes with similar frequency.
The female-to-male ratio for autoimmune gastritis has been reported to be 3:1.
Lymphocytic gastritis affects men and women at similar rates.
Age

Age is the most important variable relating to the prevalence of H pylori infection, with persons born before 1950 having a notably higher rate of infection than people born after 1950. For example, roughly one half of people older than 60 years are infected, compared with 20% of people younger than 40 years. This increase in infection prevalence with age is largely apparent rather than real, reflecting a continuing overall decline in the prevalence of H pylori infection.

Because the infection is typically acquired in childhood and is lifelong, the high proportion of older individuals (eg, 60 y or older) who are infected is the long-term result of infection that occurred in childhood when standards of living were lower. The prevalence will decrease as people who are currently aged 40 years and have a lower rate of infection grow older (a birth cohort phenomenon).

H pylori gastritis is usually acquired during childhood, and complications typically develop later.
Patients with autoimmune gastritis usually present with pernicious anemia, which is typically diagnosed in individuals aged approximately 60 years. However, pernicious anemia can be detected in children (juvenile pernicious anemia).
Lymphocytic gastritis can be observed in children but is usually detected in late adulthood. On average, patients are aged 50 years.
Eosinophilic gastroenteritis mostly affects people younger than 50 years.
Patients who are symptomatic with idiopathic granulomatous gastritis usually present when they are older than 40 years.

Clinical
History
H pylori infection: Acute H pylori infection is usually not clinically detected, but experimental infection results in a clinical syndrome characterized by epigastric pain, fullness, nausea, vomiting, flatulence, malaise, and (sometimes) fever. The symptoms resolve in about 1 week whether or not the organism is eliminated. Persistence of the organism causes H pylori chronic gastritis, which is usually asymptomatic but may manifest as gastric pain or, rarely, with nausea, vomiting, anorexia, or significant weight loss. Symptoms may occur with the development of complications of chronic H pylori gastritis, which include peptic ulcers, gastric adenocarcinoma, and MALT lymphoma.
Autoimmune gastritis: The clinical manifestations are primarily related to the deficiency in cobalamin, which is not adequately absorbed because of IF deficiency as a result of severe gastric parietal cell atrophy. The disease has an insidious onset and progresses slowly. Cobalamin deficiency affects the hematologic, gastrointestinal, and neurologic systems.
Hematologic manifestations: The most significant manifestation is megaloblastic anemia, but, rarely, purpura due to thrombocytopenia may develop. Symptoms of anemia include weakness, light-headedness, vertigo and tinnitus, palpitations, angina, and symptoms of congestive failure.
Gastrointestinal manifestations: The lack of cobalamin is associated with megaloblastosis of the gastrointestinal tract epithelium. Patients sometimes report having a sore tongue. Anorexia with moderate weight loss that is occasionally associated with diarrhea may result from malabsorption associated with megaloblastic changes of the small intestinal epithelial cells.
Neurologic manifestations: These result from demyelination, followed by axonal degeneration and neuronal death. The affected sites include peripheral nerves, posterior and lateral columns of the spinal cord, and cerebrum. Signs and symptoms include numbness and paresthesias in the extremities, weakness, and ataxia. Sphincter disturbances may occur. Mental function disturbances vary from mild irritability to severe dementia or psychosis. The neurologic disease may occur in a patient with hematocrit and red cell parameters within the reference range.
Patients with pernicious anemia have an increased frequency of gastric polyps and gastric carcinoid and a 2.9-fold increase in the frequency of gastric cancer.
Granulomatous gastritis: In multisystemic diseases, specific symptoms related to gastric involvement may be minor. Caseating granulomas secondary to tuberculosis may be found in the absence of lung disease in patients who are malnourished, immunosuppressed, or alcoholic. Patients with Crohn disease and gastric involvement may report gastric pain, nausea, and vomiting. Gastric involvement in Crohn disease is almost invariably associated with intestinal disease, and intestinal manifestations predominate. Sarcoidosis of the stomach is usually associated with granulomatous inflammation in other locations, especially the lungs, hilar nodes, or salivary glands. About 10% of patients with sarcoid involvement in the stomach are asymptomatic. Patients who are symptomatic present with gastric ulcers, hemorrhage, pyloric stricture, and gastric outlet obstruction.
Idiopathic isolated granulomatous gastritis: This diagnosis is established only when known entities associated with granulomas are excluded. Patients who are symptomatic usually are older than 40 years at presentation and have epigastric pain, weight loss, and vomiting secondary to pyloric obstruction.
Lymphocytic gastritis: This type mostly affects middle-aged or elderly patients. Lymphocytic gastritis may be associated with chronic H pylori infection, gluten-sensitive enteropathy, and Menetrier disease. It may represent a hypersensitivity reaction involving the gastric body. Lymphocytic gastritis has been described complicating MALT lymphoma and gastric carcinoma.
Eosinophilic gastroenteritis: Some patients have underlying connective tissue disorders. Patients with predominant mucosal involvement may report nausea, vomiting, and abdominal pain related to the ingestion of specific foods. Patients with involvement of the muscularis propria and resulting thickening and rigidity may present with outlet obstruction symptoms. Many patients have a history of allergy, peripheral eosinophilia, asthma, eczema, or food sensitivity. Some patients have a response to removal of these items from the diet, and their condition often responds to steroid treatment.
Gastritis in graft versus host disease: Graft versus host disease (GVHD) follows allogeneic bone marrow transplantation or transfusions, especially in patients who are immunocompromised. Patients with isolated gastric GVHD have symptoms of nausea, vomiting, and upper abdominal pain without diarrhea.13
Physical

The physical examination is of little contributory value in chronic gastritis. However, some findings are specifically associated with the particular complications of H pylori- associated gastritis and autoimmune gastritis.

In uncomplicated H pylori- associated atrophic gastritis, clinical findings are few and nonspecific.
Epigastric tenderness may exist.
If gastric ulcers coexist, guaiac-positive stool may result from occult blood loss.
Bad breath (ie, halitosis) and abdominal pain or discomfort may occur, with bloating associated with bacterial overgrowth syndrome.
Physical findings may result from the development of pernicious anemia and neurologic complications in patients with autoimmune atrophic gastritis.
With severe cobalamin deficiency, the patient is pale and has slightly icteric skin and eyes. The pulse is rapid, and the heart may be enlarged. Auscultation usually reveals a systolic flow murmur.

Causes

See Gastroesophageal Reflux Disease. Types of chronic gastritis include the following:

Infectious gastritis
Chronic gastritis caused by H pylori infection - This is the most common cause of chronic gastritis.
Infection by Helicobacter heilmannii
Granulomatous gastritis associated with gastric infections in mycobacteriosis, syphilis, histoplasmosis, mucormycosis, South American blastomycosis, anisakiasis, or anisakidosis
Chronic gastritis associated with parasitic infections -Strongyloides species, schistosomiasis, Diphyllobothrium latum
Viral infections such as CMV and herpes virus infection14
Noninfectious gastritis
Autoimmune gastritis
Chemical gastropathy, usually related to chronic bile reflux or NSAID and aspirin intake
Uremic gastropathy
Chronic noninfectious granulomatous gastritis,15,16 associated with the following:
Crohn disease
Sarcoidosis
Wegener granulomatosis
Foreign bodies
Cocaine use
Isolated granulomatous gastritis
Chronic granulomatous disease of childhood
Eosinophilic granuloma
Allergic granulomatosis and vasculitis
Plasma cell granulomas
Rheumatoid nodules
Tumoral amyloidosis and granulomas associated with gastric carcinoma
Gastric lymphoma
Langerhans cell histiocytosis
Lymphocytic gastritis, including gastritis associated with celiac disease (also called collagenous gastritis)17
Eosinophilic gastritis
Radiation injury to the stomach
GVHD
Ischemic gastritis18
Gastritis secondary to drug therapy
Chronic gastritis of undetermined etiology or gastritis of undetermined type (eg autistic gastritis

http://emedicine.medscape.com/article/176156-overview

Gastritis, Acute

Introduction
Background


Acute gastritis is a term covering a broad spectrum of entities that induce inflammatory changes in the gastric mucosa. The different etiologies share the same general clinical presentation. However, they differ in their unique histologic characteristics. The inflammation may involve the entire stomach (eg, pangastritis) or a region of the stomach (eg, antral gastritis). Acute gastritis can be broken down into 2 categories: erosive (eg, superficial erosions, deep erosions, hemorrhagic erosions) and nonerosive (generally caused by Helicobacter pylori).

No correlation exists between microscopic inflammation (histologic gastritis) and the presence of gastric symptoms (eg, abdominal pain, nausea, vomiting). In fact, most patients with histologic evidence of acute gastritis (inflammation) are asymptomatic. The diagnosis is usually obtained during endoscopy performed for other reasons. Acute gastritis may present with an array of symptoms, the most common being nondescript epigastric discomfort.

Other symptoms include nausea, vomiting, loss of appetite, belching, and bloating. Occasionally, acute abdominal pain can be a presenting symptom. This is the case in phlegmonous gastritis (gangrene of the stomach) where severe abdominal pain accompanied by nausea and vomiting of potentially purulent gastric contents can be the presenting symptoms. Fever, chills, and hiccups also may be present.

The diagnosis of acute gastritis may be suspected from the patient's history and can be confirmed histologically by biopsy specimens taken at endoscopy.

Epidemiologic studies reflect the widespread incidence of gastritis. In the United States, it accounts for approximately 1.8-2.1 million visits to doctors' offices each year. It is especially common in people older than 60 years.

See related CME at Evaluation of Acute Abdominal Pain Reviewed.

Pathophysiology

Acute gastritis has a number of causes, including certain drugs; alcohol; bile; ischemia; bacterial, viral, and fungal infections; acute stress (shock); radiation; allergy and food poisoning; and direct trauma. The common mechanism of injury is an imbalance between the aggressive and the defensive factors that maintain the integrity of the gastric lining (mucosa).

Acute erosive gastritis can result from the exposure to a variety of agents or factors. This is referred to as reactive gastritis. These agents/factors include nonsteroidal anti-inflammatory medications (NSAIDs), alcohol, cocaine, stress, radiation, bile reflux, and ischemia. The gastric mucosa exhibits hemorrhages, erosions, and ulcers. NSAIDs, such as aspirin, ibuprofen, and naproxen, are the most common agents associated with acute erosive gastritis. This results from oral or systemic administration of these agents either in therapeutic doses or in supratherapeutic doses.

Because of gravity, the inciting agents lie on the greater curvature of the stomach. This partly explains the development of acute gastritis distally on or near the greater curvature of the stomach in the case of orally administered NSAIDs. However, the major mechanism of injury is the reduction in prostaglandin synthesis. Prostaglandins are chemicals responsible for maintaining mechanisms that result in the protection of the mucosa from the injurious effects of the gastric acid. Long-term effects of such ingestions can include fibrosis and stricture.

Bacterial infection is another cause of acute gastritis. The corkscrew-shaped bacterium called H pylori is the most common cause of gastritis. Complications result from a chronic infection rather than from an acute infection. The prevalence of H pylori in otherwise healthy individuals varies depending on age, socioeconomic class, and country of origin. The infection is usually acquired in childhood. In the Western world, the number of people infected with H pylori increases with age. Evidence of H pylori infection can be found in 20% of individuals younger than 40 years and in 50% of individuals older than 60 years. How the bacterium is transmitted is not entirely clear. Transmission is likely from person to person through the oral-fecal route or through the ingestion of contaminated water or food. This is why the prevalence is higher in lower socioeconomic classes and in developing countries. H pylori is associated with 60% of gastric ulcersand80%ofduodenal ulcers.

H pylori gastritis typically starts as an acute gastritis in the antrum, causing intense inflammation, and over time, it may extend to involve the entire gastric mucosa resulting in chronic gastritis.

The acute gastritis encountered with H pylori is usually asymptomatic. The bacterium imbeds itself in the mucous layer, a protective layer that coats the gastric mucosa. It protects itself from the acidity of the stomach through the production of large amounts of urease, an enzyme that catalyzes the breakdown of urea to the alkaline ammonia and carbon dioxide. The alkaline ammonia neutralizes the gastric acid in the immediate vicinity of the bacterium conferring protection.

H pylori also has flagella that enable it to move and help it to penetrate the mucous layer so that it comes into contact with gastric epithelial cells. It also has several adhesions that help it to adhere to these cells. It produces inflammation by activating a number of toxins and enzymes that activate IL-8, which eventually attracts polymorphs and monocytes that cause acute gastritis.

Antigen-presenting cells activate lymphocytes and other mononuclear cells that lead to chronic superficial gastritis. The infection is established within a few weeks after the primary exposure to H pylori. It produces inflammation via the production of a number of toxins and enzymes. The intense inflammation can result in the loss of gastric glands responsible for the production of acid. This is referred to as atrophic gastritis. Consequently, gastric acid production drops. The virulence genotype of the microbe is an important determinant for the severity of the gastritis and the formation of intestinal metaplasia, the transformation of gastric epithelium. This transformation can lead to gastric cancer.
Reactive gastropathy is the second most common diagnosis made on gastric biopsy specimens after H pylori gastritis. This entity is believed to be secondary to bile reflux and was originally reported after partial gastrectomy (Billroth I or II). It is now considered to represent a nonspecific response to a variety of other gastric irritants.

Helicobacter heilmanii is a gram-negative, tightly spiraled, helical-shaped organism with 5-7 turns. The prevalence of H heilmanii is extremely low (0.25-1.5%). The source of H heilmanii infection is unclear, but animal contact is thought to be the means of transmission.

Tuberculosis is a rare cause of gastritis, but an increasing number of cases have developed because of patients who are immunocompromised. Gastritis caused by tuberculosis is generally associated with pulmonary or disseminated disease.

Secondary syphilis of the stomach is a rare cause of gastritis.

Phlegmonous gastritis is an uncommon form of gastritis caused by numerous bacterial agents, including streptococci, staphylococci, Proteus species, Clostridium species, and Escherichia coli. Phlegmonous gastritis usually occurs in individuals who are debilitated. It is associated with a recent large intake of alcohol, a concomitant upper respiratory tract infection, and AIDS. Phlegmonous means a diffuse spreading inflammation of or within connective tissue. In the stomach, it implies infection of the deeper layers of the stomach (submucosa and muscularis). As a result, purulent bacterial infection may lead to gangrene. Phlegmonous gastritis is rare. The clinical diagnosis is usually established in the operating room, as these patients present with an acute abdominal emergency requiring immediate surgical exploration. Without appropriate therapy, it progresses to peritonitis and death.

Viral infections can cause gastritis. Cytomegalovirus (CMV) is a common viral cause of gastritis. It is usually encountered in individuals who are immunocompromised, including those with cancer, immunosuppression, transplants, and AIDS. Gastric involvement can be localized or diffuse.

Fungal infections that cause gastritis include Candida albicans and histoplasmosis. Gastric phycomycosis is another rare lethal fungal infection. The common predisposing factor is immunosuppression. C albicans rarely involves the gastric mucosa. When isolated in the stomach, the most common locations tend to be within a gastric ulcer or an erosion bed. It is generally of little consequence. Disseminated histoplasmosis can involve the stomach. The usual presenting clinical feature is bleeding from gastric ulcers or erosions on giant gastric folds.

Parasitic infections are rare causes of gastritis. Anisakidosis is caused by a nematode that embeds itself in the gastric mucosa along the greater curvature. Anisakidosis is acquired by eating contaminated sushi and other types of contaminated raw fish. It often causes severe abdominal pain that subsides within a few days. This nematode infection is associated with gastric fold swelling, erosions, and ulcers.

Ulcero-hemorrhagic gastritis is most commonly seen in patients who are critically ill. Ulcero-hemorrhagic gastritis is believed to be secondary to ischemia related to hypotension and shock or to the release of vasoconstrictive substances, but the etiology is often unknown. The gastric mucosa reveals multiple petechiae, mostly in the fundus and body, or exhibits a diffusely hemorrhagic pattern. The gross pathology may resemble that of NSAID- or other ingestion-induced gastritis, except that the location of injury is different. This form of gastritis can be life-threatening if the patient experiences hemorrhaging and may even require emergency gastrectomy.

Microscopic evidence of acute gastritis can be seen in patients with Crohn disease, though clinical manifestations are rare (occurring in only about 2-7% of patients with Crohn disease). Focally enhancing gastritis is now recognized as a condition seen in both Crohn disease and ulcerative colitis.

Eosinophilic gastritis is often seen in conjunction with eosinophilic gastroenteritis but can be associated with various disorders, including food allergies (eg, cow milk, soy protein), collagen vascular diseases, parasitic infections, gastric cancer, lymphoma, Crohn disease, vasculitis, drug allergies, and H pylori infections. An eosinophilic infiltrate is seen involving the gastric wall or epithelium.

Mortality/Morbidity

The mortality/morbidity is dependent on the etiology of the gastritis. Generally, most cases of gastritis are treatable once the etiology is determined. The exception to this is phlegmonous gastritis, which has a mortality rate of 65%, even with treatment.
Sex

No sexual predilection exists.
Age

Gastritis affects all age groups. The incidence of H pylori infection increases with age.
Clinical
History
Gnawing or burning epigastric distress, occasionally accompanied by nausea and/or vomiting. The pain may improve or worsen with eating.
Previous mucosal injury (eg, gastritis, peptic ulcer disease, endoscopic injury caused by polypectomy, injury caused by any surgery)
History of eating raw fish
Exposure to potentially noxious drugs or chemical agents. This includes corticosteroids or other prescription medications that can cause gastritis.
Routine use of aspirin or NSAIDs, especially at high doses
Physical

The physical examination findings are often normal with occasional mild epigastric tenderness. The examination tends to exhibit more abnormalities as the patient develops complications in relation to gastritis.
Causes

Acute gastritis has a number of causes, including certain drugs; alcohol; bacterial, viral, and fungal infections; acute stress (shock); radiation; allergy and food poisoning; bile; ischemia; and direct trauma.
Drugs
NSAIDs, such as aspirin, ibuprofen, and naproxen
Cocaine
Iron
Colchicine, when at toxic levels, as in patients with failing renal or hepatic function
Kayexalate
Chemotherapeutic agents, such as mitomycin C, 5-fluoro-2-deoxyuridine, and floxuridine
Potent alcoholic beverages, such as whisky, vodka, and gin
Bacterial infections
H pylori (most frequent)
H heilmanii (rare)
Streptococci (rare)
Staphylococci (rare)
Proteus species (rare)
Clostridium species (rare)
E coli (rare)
Tuberculosis (rare)
Secondary syphilis (rare)
Viral infections (eg, CMV)
Fungal infections
Candidiasis
Histoplasmosis
Phycomycosis
Parasitic infection (eg, anisakidosis)
Acute stress (shock)
Radiation
Allergy and food poisoning
Bile: The reflux of bile (an alkaline medium important for the activation of digestive enzymes in the small intestine) from the small intestine to the stomach can induce gastritis.
Ischemia: This term is used to refer to damage induced by decreased blood supply to the stomach. This rare etiology is due to the rich blood supply to the stomach.
Direct trauma

http://emedicine.medscape.com/article/175909-overview

Trik Hilangkan Efek Negatif Rokok

Penulis : Ikarowina Tarigan

KEBIASAAN merokok di masa lalu tidak perlu menghantui langkah Anda dalam memulai pola hidup sehat. Anda bisa memperbaiki efek negatif kecanduan rokok sebelumnya. Berikut efek negatif rokok dan langkah-langkah yang bisa Anda lakukan untuk memperbaiki kerusakan yang ditimbulkan.

Kanker paru-paru merupakan salah satu kanker penyebab kematian utama pada perempuan. Menurut penelitian, 4,000 zat kimia pada tembakau jauh lebih mematikan saat dicerna perempuan dibandingkan laki-laki.

Akan tetapi, Anda bisa mengurangi risiko dengan berhenti merokok. Setelah berhenti selama 10 tahun, mantan perokok dinyatakan memiliki risiko kanker paru-paru yang setara dengan mereka yang tidak pernah merokok.

Sayangnya, kerusakan paru-paru akibat emfisema atau bronkitis tidak bisa diperbaiki. Tapi, sisitem kerdiovaskular Anda akan kembali berjalan baik.

"Fungsi pembuluh darah akan membaik setelah 24 jam berhenti merokok. Setelah 1 tahun, risiko serangan jantung berkurang sebesar 50 persen," terang direktur Women's Heart Clinic di the Mayo Clinic, Rochester Sharonne Hayes, MD.

Dan dalam waktu 15 tahun, risiko penyakit jantung Anda sama dengan mereka yng tidak pernah merokok sepanjang hidup. Selain itu, olahraga 30 menit sehari bisa mempercepat pemulihan fungsi jantung.

Mencegah risiko kanker jangka panjang merupakan usulan yang suram, tapi Anda tetap bisa melindungi kesehatan dengan menerapkan kiat-kiat tertentu. Setiap orang dianjurkan mengonsumsi paling tidak 5-7 takar buah dan sayuran sehari. Dan mantan perokok disarankan menambah asupan 1-2 takar stroberi serta black atau red raspberries. Cara ini diyakini bisa mencegah perkembangan kanker kerongkongan.

Selain itu, cobalah menambah asupan folat dan vitamin B12 melalui diet Anda. Studi dari Ohio State University menemukan, mengonsumsi folat (terkandung dalam whole grain dan sayur-sayuran hijau) dan vitamin B12 (terkandung dalam daging dan produk susu) 1 atau 2 kali sehari bisa mengurangi kerusakan sel, yang bisa memicu kanker.

Di samping itu, Anda yang telah merokok sebanyak 1 bungkus rokok sehari selama 10 tahun atau lebih sebaiknya menjalani tes screening CT-scan dosis rendah selama 25 detik untuk memeriksa kemungkinan kanker paru-paru. Cara ini meungkinkan dokter mendeteksi tumor lebih awal. Tes ini dinyatakan bisa memperbesar kemungkinan pemulihan pasien. (OL-05)

http://www.mediaindonesia.com/mediahidupsehat/index.php/read/2009/12/30/2006/4/Trik-Hilangkan-Efek-Negatif-Rokok

Thalasemia Bisa Dicegah

JAKARTA--Sekalipun tergolong penyakit genetis atau turunan, Thalasemia atau penyakit kelainan darah bisa dicegah sejak dini. Thalasemia disebabkan kurangnya produksi hemoglobin (sel darah merah) sebagai akibat terjadinya gangguan dalam proses pembentukan rantai sel darah karena kerusakan gen dalam tubuh..

Demikian penjelasan, Prof. Dr. Iskandar Wahidiyat, Pakar Thalasemia Rumah sakit Cipto Mangunkusomo Jakarta, dalam Acara perkenalan Program Duta Thalasemia yang digagas Novartis Indonesia di Jakarta, baru-baru ini. Turut hadir, penderita Thalasemia yang ditunjuk menjadi Duta Thalasemia, Thariq Hidayat Kanz, 17 tahun, asal Ciledug, Tangerang, Jawa Barat.

Iskandar menjelaskan, hingga sekarang ini keberadaan Thalasemia merupakan penyakit menurun terbanyak di dunia. Berdasarkan data terakhir yang dikutipnya dari Badan Organisasi Kesehatan Dunia (WHO) menyebutkan 250 juta penduduk dunia (4.5%) membawa genetik Thalasemia. Dari 250 juta, 80-90 juta diantaranya membawa genetik Thalasemia Beta.

"Sementara itu, 300 ribu anak terinfeksi tiap tahunnya, dan 60-70 ribu diantara menderita Thalasemia Beta. Secara keseluruhan populasi pembawa genetik Thalasema naik secara signifikan," paparnya.

Di Indonesia sendiri, masih Iskandar menjelaskan, jumlah penderita Thalasemia mengalami kenaikan. Pada tahun 1994, Iskandar memperkirakan jumlah penderita Thalesemia mencapai 500 jiwa. Angka tersebut meningkat 3 kali lipat menjadi 1500 jiwa pada tahun 2008, dan dia memprediksikan pada tahun 2020 nanti, angka penderita Thalasemia naik drastis menjadi 22500 jiwa.

"Sejauh ini pemerintah tidak menjalankan program penanganan secara total lantaran masih fokus menangani penyakit infeksi," imbuhnya.

Padahal, kata dia, untuk menangani penderita Thalasemia dibutuhkan dana yang cukup besar. Berdasarkan perhitungan RSCM, setiap penderita Thalasemia membutuhkan anggaran 300 juta pertahun guna mengobati penyakit tersebut. Angka itu bakalan melonjak drastis menjadi 50 triliun rupiah pertahun di tahun 2020. "Angka ini harusnya bisa dialokasikan buat anggaran pendidikan," imbuhnya.

Sebab itu, Iskandar melihat, pencegahan jauh lebih efektif guna menekan pembiayaan kesehatan yang dikeluarkan untuk mengobati Thalasemia.

Terkait masalah faktor genetis sebagai batu sandungan melakukan langkah pencegahah,Dia berpendapat, tidak ada masalah dengan faktor genetis yang selama ini diartikan sebagai faktor pemberat berjalannya program pencegahan.

Prof. Iskandar lantas menyarankan beberapa langkah pencegahan yang idealnya segera dilakukan pemerintah yaitu, pertama dan paling esensial adalah peran pemerintah. "Siprus misalnya, berkat komitmen pemerintahnya, mereka mampu menekan angka penderita Thalasemia menjadi 0%, dan coba bandingkan dengan Inggris, yang pemerintahnya tidak berkomitmen lantara banyak penduduk asing. Akibatnya, angka penderita Thalasemia di negara itui naik signifikan," ungkapnya.

Sementara itu, faktor lainya antara lain, pemenuhan pendidikan kesehatan, Screening, penciptaan laboratorium untuk screening dan pra natal, serta genetik konseling. "Melalui langkah-langkah itu, sangat memungkinkan berhasilnya penurunan angka penderita Thalasemia," pungkasnya.

Pentingnya Screening

Sementara itu, bila di negara barat mewajibkan penderita Thalasemia melakukan screening, di Indonesia sendiri terhitung belum mengenal hal itu. Akibatnya, penyebaran Thalasemia tidak bisa dikontrol.

"Di Italia misalnya, sebelum melakukan pernikahan, masing-masing pasangan harus menunjukan surat hasil screening. Dari situ, pihak konseling memberikan saran terkait dampak yang diakibatkan pernikahan itu," ungkap Pakar Thalasemia, Prof. Dr. Prastika Wahidiyat.

"Hanya dari 1% dari mereka yang tidak melanjutkan pernikahan tersebut. Tapi mereka melakukan beberapa langkah seperti melakukan adopsi anak, atau melakukan pemeriksaan kandungan saat usia 10 minggu," tuturnya.

Dia mengungkapkan, hal-hal semacam itu sudah banyak dilakukan dibeberapa negara termasuk negara Islam seperti Iran.

"Sudah selayaknya Indonesia menjalankan hal serupa. Terlebih, Indonesia terdiri dari beribu-ribu suku yang menyebar di setiap pula. Melalui keberadaan surat keterangan screening Thalesemia bisa menekan lahu penyebaran penyakit tersebut," tegasnya. cr2/rin

http://republika.co.id/berita/99281/Thalasemia_Bisa_Dicegah

Surah 1 - Al Fatiha THE OPENING

001.001 In the name of God, Most Gracious, Most Merciful.

001.002 Praise be to God, the Cherisher and Sustainer of the Worlds;

001.003 Most Gracious, Most Merciful;

001.004 Master of the Day of Judgment.

001.005 Thee do we worship, and Thine aid we seek.

001.006 Show us the straight way,

001.007 The way of those on whom Thou hast bestowed Thy Grace, those whose (portion) is not wrath, and who go not astray.

Surah 2 - Al Baqarah THE HEIFER

002.001 Alif, Lam, Mim.

002.002 This is the Book; in it is guidance sure, without doubt, to those who fear God;

002.003 Who believe in the Unseen, are steadfast in prayer, and spend out of what We have provided for them;

002.004 And who believe in the Revelation sent to thee, and sent before thy time, and (in their hearts) have the assurance of the Hereafter.

002.005 They are on (true) guidance, from their Lord, and it is these who will prosper.

002.006 As to those who reject Faith, it is the same to them whether thou warn them or do not warn them; they will not believe.

002.007 God hath set a seal on their hearts and on their hearing, and on their eyes is a veil; great is the penalty they (incur).

002.008 Of the people there are some who say: "We believe in God and the Last Day;" but they do not (really) believe.

002.009 Fain would they deceive Allah and those who believe, but they only deceive themselves, and realise (it) not!

002.010 In their hearts is a disease; and Allah has increased their disease: And grievous is the penalty they (incur), because they are false (to themselves).

002.011 When it is said to them: "Make not mischief on the earth," they say: "Why, we only want to make peace!"

002.012 Of a surety, they are the ones who make mischief, but they realise (it) not.

002.013 When it is said to them: "Believe as the others believe:" They say: "Shall we believe as the fools believe?" Nay, of a surety they are the fools, but they do not know.

002.014 When they meet those who believe, they say: "We believe;" but when they are alone with their evil ones, they say: "We are really with you: We (were) only jesting."

002.015 God will throw back their mockery on them, and give them rope in their trespasses; so they will wander like blind ones (to and fro).

002.016 These are they who have bartered Guidance for error: But their traffic is profitless, and they have lost true direction.

002.017 Their similitude is that of a man who kindled a fire; when it lighted all around him, God took away their light and left them in utter darkness. So they could not see.

002.018 Deaf, dumb, and blind, they will not return (to the path).

002.019 Or (another similitude) is that of a rain-laden cloud from the sky: In it are zones of darkness, and thunder and lightning: They press their fingers in their ears to keep out the stunning thunder-clap, the while they are in terror of death. But God is ever round the rejecters of Faith!

002.020 The lightning all but snatches away their sight; every time the light (Helps) them, they walk therein, and when the darkness grows on them, they stand still. And if God willed, He could take away their faculty of hearing and seeing; for God hath power over all things.

002.021 O ye people! Adore your Guardian-Lord, who created you and those who came before you, that you may become righteous;

002.022 Who has made the earth your couch, and the heavens your canopy; and sent down rain from the heavens; and brought forth therewith Fruits for your sustenance; then set not up rivals unto God when ye know (the truth).

002.023 And if ye are in doubt as to what We have revealed from time to time to Our servant, then produce a Sura like thereunto; and call your witnesses or helpers (If there are any) besides God, if your (doubts) are true.

002.024 But if ye cannot- and of a surety ye cannot- then fear the Fire whose fuel is Men and Stones,- which is prepared for those who reject Faith.

002.025 But give glad tidings to those who believe and work righteousness, that their portion is Gardens, beneath which rivers flow. Every time they are fed with fruits therefrom, they say: "Why, this is what we were fed with before," for they are given things in similitude; and they have therein companions pure (and holy); and they abide therein (forever).

002.026 God disdains not to use the similitude of things, lowest as well as highest. Those who believe know that it is truth from their Lord; but those who reject faith say: "What means God by this similitude?" By it He causes many to stray, and many He leads into the right path; but He causes not to stray, except those who forsake (the path),-

002.027 Those who break God's Covenant after it is ratified, and who sunder what God has ordered to be joined, and do mischief on earth: These cause loss (only) to themselves.

002.028 How can ye reject the faith in God?- seeing that ye were without life, and He gave you life; then will He cause you to die, and will again bring you to life; and again to Him will ye return.

002.029 It is He Who hath created for you all things that are on earth; Then He turned to the heaven and made them into seven firmaments; and of all things He hath perfect knowledge.

002.030 Behold, thy Lord said to the angels: "I will create a vicegerent on earth." They said: "Wilt Thou place therein one who will make mischief therein and shed blood?- whilst we do celebrate Thy praises and glorify Thy holy (name)?" He said: "I know what ye know not."

002.031 And He taught Adam the names of all things; then He placed them before the angels, and said: "Tell me the names of these if ye are right."

002.032 They said: "Glory to Thee, of knowledge we have none, save what Thou Hast taught us: In truth it is Thou Who art perfect in knowledge and wisdom."

002.033 He said: "O Adam! Tell them their names." When he had told them their names, God said: "Did I not tell you that I know the secrets of heaven and earth, and I know what ye reveal and what ye conceal?"

002.034 And behold, We said to the angels: "Bow down to Adam" and they bowed down. Not so Iblis: he refused and was haughty: he was of those who reject Faith.

002.035 And We said: "O Adam! dwell thou and thy wife in the Garden; and eat of the bountiful things therein as (where and when) ye will; but approach not this tree, or ye run into harm and transgression."

002.036 Then did Satan make them slip from the (Garden), and get them out of the state (of felicity) in which they had been. And We said: "Get ye down, all (ye people), with enmity between yourselves. On earth will be your dwelling-place and your means of livelihood - for a time."

002.037 Then learnt Adam from his Lord words of inspiration, and his Lord turned towards him; for He is Oft-Returning, Most Merciful.

002.038 We said: "Get ye down all from here; and if, as is sure, there comes to you Guidance from me, whosoever follows My guidance, on them shall be no fear, nor shall they grieve.

002.039 "But those who reject Faith and belie Our Signs, they shall be Companions of the Fire; they shall abide therein."

002.040 O Children of Israel! call to mind the (special) favour which I bestowed upon you, and fulfil your covenant with Me as I fulfil My Covenant with you, and fear none but Me.

002.041 And believe in what I reveal, confirming the revelation which is with you, and be not the first to reject faith therein, nor sell My Signs for a small price; and fear Me, and Me alone.

002.042 And cover not Truth with falsehood, nor conceal the Truth when ye know (what it is).

002.043 And be steadfast in prayer; practise regular charity; and bow down your heads with those who bow down (in worship).

002.044 Do ye enjoin right conduct on the people, and forget (to practise it) yourselves, and yet ye study the Scripture? Will ye not understand?

002.045 Nay, seek (God's) help with patient perseverance and prayer: It is indeed hard, except to those who bring a lowly spirit,-

002.046 Who bear in mind the certainty that they are to meet their Lord, and that they are to return to Him.

002.047 Children of Israel! call to mind the (special) favour which I bestowed upon you, and that I preferred you to all other (for My Message).

002.048 Then guard yourselves against a day when one soul shall not avail another nor shall intercession be accepted for her, nor shall compensation be taken from her, nor shall anyone be helped (from outside).

002.049 And remember, We delivered you from the people of Pharaoh: they set you hard tasks and punishments, slaughtered your sons and let your women-folk live; therein was a tremendous trial from your Lord.

002.050 And remember We divided the sea for you and saved you and drowned Pharaoh's people within your very sight.

002.051 And remember We appointed forty nights for Moses, and in his absence ye took the calf (for worship), and ye did grievous wrong.

002.052 Even then We did forgive you; there was a chance for you to be grateful.

002.053 And remember We gave Moses the Scripture and the Criterion (between right and wrong): There was a chance for you to be guided aright.

002.054 And remember Moses said to his people: "O my people! Ye have indeed wronged yourselves by your worship of the calf: So turn (in repentance) to your Maker, and slay yourselves (the wrong-doers); that will be better for you in the sight of your Maker." Then He turned towards you (in forgiveness): For He is Oft-Returning, Most Merciful.

002.055 And remember ye said: "O Moses! We shall never believe in thee until we see God manifestly," but ye were dazed with thunder and lighting even as ye looked on.

002.056 Then We raised you up after your death: Ye had the chance to be grateful.

002.057 And We gave you the shade of clouds and sent down to you Manna and quails, saying: "Eat of the good things We have provided for you:" (But they rebelled); to Us they did no harm, but they harmed their own souls.

002.058 And remember We said: "Enter this town, and eat of the plenty therein as ye wish; but enter the gate with humility, in posture and in words, and We shall forgive you your faults and increase (the portion of) those who do good."

002.059 But the transgressors changed the word from that which had been given them; so We sent on the transgressors a plague from heaven, for that they infringed (Our command) repeatedly.

002.060 And remember Moses prayed for water for his people; We said: "Strike the rock with thy staff." Then gushed forth therefrom twelve springs. Each group knew its own place for water. So eat and drink of the sustenance provided by God, and do no evil nor mischief on the (face of the) earth.

002.061 And remember ye said: "O Moses! we cannot endure one kind of food (always); so beseech thy Lord for us to produce for us of what the earth groweth, -its pot-herbs, and cucumbers, Its garlic, lentils, and onions." He said: "Will ye exchange the better for the worse? Go ye down to any town, and ye shall find what ye want!" They were covered with humiliation and misery; they drew on themselves the wrath of God. This because they went on rejecting the Signs of God and slaying His Messengers without just cause. This because they rebelled and went on transgressing.

002.062 Those who believe (in the Qur'an), and those who follow the Jewish (scriptures), and the Christians and the Sabians,- any who believe in God and the Last Day, and work righteousness, shall have their reward with their Lord; on them shall be no fear, nor shall they grieve.

002.063 And remember We took your covenant and We raised above you (The towering height) of Mount (Sinai) (Saying): "Hold firmly to what We have given you and bring (ever) to remembrance what is therein: Perchance ye may fear God."

002.064 But ye turned back thereafter: Had it not been for the Grace and Mercy of God to you, ye had surely been among the lost.

002.065 And well ye knew those amongst you who transgressed in the matter of the Sabbath; We said to them: "Be ye apes, despised and rejected."

002.066 So We made it an example to their own time and to their posterity, and a lesson to those who fear God.

002.067 And remember Moses said to his people: "God commands that ye sacrifice a heifer." They said: "Makest thou a laughing-stock of us?" He said: "God save me from being an ignorant (fool)!"

002.068 They said: "Beseech on our behalf Thy Lord to make plain to us what (heifer) it is!" He said; "He says: The heifer should be neither too old nor to o young, but of middling age. Now do what ye are commanded!"

002.069 They said: "Beseech on our behalf Thy Lord to make plain to us her colour." He said: "He says: A fawn-coloured heifer, pure and rich in tone, the admiration of beholders!"

002.070 They said: "Beseech on our behalf Thy Lord to make plain to us what she is: To us are all heifers alike: We wish indeed for guidance, if God wills."

002.071 He said: "He says: A heifer not trained to till the soil or water the fields; sound and without blemish." They said: "Now hast thou brought the truth." Then they offered her in sacrifice, but not with good-will.

002.072 Remember ye slew a man and fell into a dispute among yourselves as to the crime: But God was to bring forth what ye did hide.

002.073 So We said: "Strike the (body) with a piece of the (heifer)." Thus God bringeth the dead to life and showeth you His Signs: Perchance ye may understand.

002.074 Thenceforth were your hearts hardened: They became like a rock and even worse in hardness. For among rocks there are some from which rivers gush forth; others there are which when split asunder send forth water; and others which sink for fear of God. And God is not unmindful of what ye do.

002.075 Can ye (o ye men of Faith) entertain the hope that they will believe in you?- Seeing that a party of them heard the Word of God, and perverted it knowingly after they understood it.

002.076 Behold! when they meet the men of Faith, they say: "We believe": But when they meet each other in private, they say: "Shall you tell them what God hath revealed to you, that they may engage you in argument about it before your Lord?"- Do ye not understand (their aim)?

002.077 Know they not that God knoweth what they conceal and what they reveal?

002.078 And there are among them illiterates, who know not the Book, but (see therein their own) desires, and they do nothing but conjecture.

002.079 Then woe to those who write the Book with their own hands, and then say:"This is from God," to traffic with it for a miserable price!- Woe to them for what their hands do write, and for the gain they make thereby.

002.080 And they say: "The Fire shall not touch us but for a few numbered days:" Say: "Have ye taken a promise from God, for He never breaks His promise? Or is it that ye say of God what ye do not know?"

002.081 Nay, those who seek gain in evil, and are girt round by their sins,- they are Companions of the Fire: Therein shall they abide (forever).

002.082 But those who have faith and work righteousness, they are companions of the Garden: Therein shall they abide (For ever).

002.083 And remember We took a covenant from the Children of Israel (to this effect): Worship none but God; treat with kindness your parents and kindred, and orphans and those in need; speak fair to the people; be steadfast in prayer; and practise regular charity. Then did ye turn back, except a few among you, and ye backslide (even now).

002.084 And remember We took your covenant (to this effect): Shed no blood amongst you, nor turn out your own people from your homes: and this ye solemnly ratified, and to this ye can bear witness.

002.085 After this it is ye, the same people, who slay among yourselves, and banish a party of you from their homes; assist (their enemies) against them, in guilt and transgression; and if they come to you as captives, ye ransom them, though it was not lawful for you to banish them. Then is it only a part of the Book that ye believe in, and do ye reject the rest? But what is the reward for those among you who behave like this but disgrace in this life?- and on the Day of Judgment they shall be consigned to the most grievous penalty. For God is not unmindful of what ye do.

002.086 These are the people who buy the life of this world at the price of the Hereafter: their penalty shall not be lightened nor shall they be helped.

002.087 We gave Moses the Book and followed him up with a succession of apostles; We gave Jesus the son of Mary Clear (Signs) and strengthened him with the Holy Spirit. Is it that whenever there comes to you an apostle with what ye yourselves desire not, ye are puffed up with pride?- Some ye called impostors, and others ye slay!

002.088 They say, "Our hearts are the wrappings (which preserve God's Word: we need no more)." Nay, God's curse is on them for their blasphemy: Little is it they believe.

002.089 And when there comes to them a Book from God, confirming what is with them,- although from of old they had prayed for victory against those without Faith,- when there comes to them that which they (should) have recognised, they refuse to believe in it but the curse of God is on those without Faith.

002.090 Miserable is the price for which they have sold their souls, in that they deny (the revelation) which God has sent down, in insolent envy that God of His Grace should send it to any of His servants He pleases: Thus have they drawn on themselves Wrath upon Wrath. And humiliating is the punishment of those who reject Faith.

002.091 When it is said to them, "Believe in what God Hath sent down, "they say, "We believe in what was sent down to us:" yet they reject all besides, even if it be Truth confirming what is with them. Say: "Why then have ye slain the prophets of God in times gone by, if ye did indeed believe?"

002.092 There came to you Moses with clear (Signs); yet ye worshipped the Calf (even) after that, and ye did behave wrongfully.

002.093 And remember We took your Covenant and We raised above you (the towering height) of Mount (Sinai): (Saying): "Hold firmly to what We have given you, and hearken (to the Law)": They said:"We hear, and we disobey:" And they had to drink into their hearts (of the taint) of the Calf because of their Faithlessness. Say: "Vile indeed are the behests of your Faith if ye have any faith!"

002.094 Say: "If the last Home, with God, be for you specially, and not for anyone else, then seek ye for death, if ye are sincere."

002.095 But they will never seek for death, on account of the (sins) which their hands have sent on before them. And God is well-acquainted with the wrong-doers .

002.096 Thou wilt indeed find them, of all people, most greedy of life,-even more than the idolaters: Each one of them wishes He could be given a life of a thousand years: But the grant of such life will not save him from (due) punishment. For God sees well all that they do.

002.097 Say: Whoever is an enemy to Gabriel-for he brings down the (revelation) to thy heart by God's will, a confirmation of what went before, and guidance and glad tidings for those who believe,-

002.098 Whoever is an enemy to God and His angels and apostles, to Gabriel and Michael,- Lo! God is an enemy to those who reject Faith.

002.099 We have sent down to thee Manifest Signs (ayat); and none reject them but those who are perverse.

002.100 Is it not (the case) that every time they make a Covenant, some party among them throw it aside?- Nay, Most of them are faithless.

002.101 And when there came to them an apostle from God, confirming what was with them, a Party of the People of the Book threw away the Book of God behind their backs, as if (it had been something) they did not know!

002.102 They followed what the evil ones gave out (falsely) against the power of Solomon: the blasphemers were, not Solomon, but the evil ones, teaching men magic, and such things as came down at Babylon to the angels Harut and Marut. But neither of these taught anyone (such things) without saying: "We are only for trial; so do not blaspheme." They learned from them the means to sow discord between man and wife. But they could not thus harm anyone except by God's permission. And they learned what harmed them, not what profited them. And they knew that the buyers of (magic) would have no share in the happiness of the Hereafter. And vile was the price for which they did sell their souls, if they but knew!

002.103 If they had kept their Faith and guarded themselves from evil, far better had been the reward from their Lord, if they but knew!

002.104 O ye of Faith! Say not (to the Apostle) words of ambiguous import, but words of respect; and hearken (to him): To those without Faith is a grievous punishment.

002.105 It is never the wish of those without Faith among the People of the Book, nor of the Pagans, that anything good should come down to you from your Lord. But God will choose for His special Mercy whom He will - for God is Lord of grace abounding.

002.106 None of Our revelations do We abrogate or cause to be forgotten, but We substitute something better or similar: Knowest thou not that God Hath power over all things?

002.107 Knowest thou not that to God belongeth the dominion of the heavens and the earth? And besides Him ye have neither patron nor helper.

002.108 Would ye question your Apostle as Moses was questioned of old? but whoever changeth from Faith to Unbelief, Hath strayed without doubt from the even way.

002.109 Quite a number of the People of the Book wish they could Turn you (people) back to infidelity after ye have believed, from selfish envy, after the Truth hath become Manifest unto them: But forgive and overlook, till God accomplishes His purpose; for God Hath power over all things.

002.110 And be steadfast in prayer and regular in charity: And whatever good ye send forth for your souls before you, ye shall find it with God: for God sees Well all that ye do.

002.111 And they say: "None shall enter Paradise unless he be a Jew or a Christian." Those are their (vain) desires. Say: "Produce your proof if ye are truthful."

002.112 Nay,-whoever submits His whole self to God and is a doer of good,- He will get his reward with his Lord; on such shall be no fear, nor shall they grieve.

002.113 The Jews say: "The Christians have naught (to stand) upon; and the Christians say: "The Jews have naught (to stand) upon." Yet they (profess to) study the (same) Book. Like unto their word is what those say who know not; but God will judge between them in their quarrel on the Day of Judgment.

002.114 And who is more unjust than he who forbids that in places for the worship of God, His name should be celebrated?-whose zeal is (in fact) to ruin them? It was not fitting that such should themselves enter them except in fear. For them there is nothing but disgrace in this world, and in the world to come, an exceeding torment.

002.115 To God belong the East and the West: Whithersoever ye turn, there is God's countenance. For God is all-Embracing, all-Knowing.

002.116 They say: "God hath begotten a son" :Glory be to Him.-Nay, to Him belongs all that is in the heavens and on earth: everything renders worship to Him.

002.117 To Him is due the primal origin of the heavens and the earth: When He decreeth a matter, He saith to it: "Be," and it is.

002.118 Say those without knowledge: "Why speaketh not God unto us? Or why cometh not unto us a Sign?" So said the people before them words of similar import. Their hearts are alike. We have indeed made clear the Signs unto any people who hold firmly to Faith (in their hearts).

002.119 Verily, We have sent thee in truth as a bearer of glad tidings and a warner: But of thee no question shall be asked of the Companions of the Blazing Fire.

002.120 Never will the Jews or the Christians be satisfied with thee unless thou follow their form of religion. Say: "The Guidance of God,-that is the (only) Guidance." Wert thou to follow their desires after the knowledge which hath reached thee, then wouldst thou find neither Protector nor Helper against God.

002.121 Those to whom We have sent the Book study it as it should be studied: They are the ones that believe therein: Those who reject faith therein,- the loss is their own.

002.122 O Children of Israel! call to mind the special favour which I bestowed upon you, and that I preferred you to all others (for My Message).

002.123 Then guard yourselves against a Day when one soul shall not avail another, nor shall compensation be accepted from her nor shall intercession profit her nor shall anyone be helped (from outside).

002.124 And remember that Abraham was tried by his Lord with certain Commands, which he fulfilled: He said: "I will make thee an Imam to the Nations." He pleaded: "And also (Imams) from my offspring!" He answered: "But My Promise is not within the reach of evil-doers."

002.125 Remember We made the House a place of assembly for men and a place of safety; and take ye the station of Abraham as a place of prayer; and We covenanted with Abraham and Isma'il, that they should sanctify My House for those who compass it round, or use it as a retreat, or bow, or prostrate themselves (therein in prayer).

002.126 And remember Abraham said: "My Lord, make this a City of Peace, and feed its people with fruits,-such of them as believe in God and the Last Day." He said: "(Yea), and such as reject Faith,-for a while will I grant them their pleasure, but will soon drive them to the torment of Fire,- an evil destination (indeed)!"

002.127 And remember Abraham and Isma'il raised the foundations of the House (With this prayer): "Our Lord! Accept (this service) from us: For Thou art the All- Hearing, the All-Knowing.

002.128 "Our Lord! Make of us Muslims, bowing to Thy (Will), and of our progeny a people Muslim, bowing to Thy (will); and show us our place for the celebration of (due) rites; and turn unto us (in Mercy); for Thou art the Oft-Returning, Most Merciful.

002.129 "Our Lord! Send amongst them an Apostle of their own, who shall rehearse Thy Signs to them and instruct them in Scripture and Wisdom, and sanctify them: For Thou art the Exalted in Might, the Wise."

002.130 And who turns away from the religion of Abraham but such as debase their souls with folly? Him We chose and rendered pure in this world: And he will be in the Hereafter in the ranks of the Righteous.

002.131 Behold! His Lord said to him: "Bow (thy will to Me):" He said: "I bow (my will) to the Lord and Cherisher of the Universe."

002.132 And this was the legacy that Abraham left to his sons, and so did Jacob; "Oh my sons! God hath chosen the Faith for you; then die not except in the State of Submission (to Allah).

002.133 Were ye witnesses when Death appeared before Jacob? Behold, he said to his sons: "What will ye worship after me?" They said: "We shall worship Thy God and the God of thy fathers- of Abraham, Isma'il and Isaac,- the one (True) God: To Him we bow (in Islam)."

002.134 That was a People that hath passed away. They shall reap the fruit of what they did, and ye of what ye do! Of their merits there is no question in your case!

002.135 They say: "Become Jews or Christians if ye would be guided (To salvation)." Say thou: "Nay! (I would rather) the Religion of Abraham the True, and he joined not gods with God."

002.136 Say ye: "We believe in God, and the revelation given to us, and to Abraham, Isma'il, Isaac, Jacob, and the Tribes, and that given to Moses and Jesus, and that given to (all) Prophets from their Lord: We make no difference between one and another of them: And we bow to God (in Islam)."

002.137 So if they believe as ye believe, they are indeed on the right path; but if they turn back, it is they who are in schism; but God will suffice thee as against them, and He is the All-Hearing, the All-Knowing.

002.138 (Our religion is) the Baptism of God: And who can baptize better than God? And it is He Whom we worship.

002.139 Say: Will ye dispute with us about God, seeing that He is our Lord and your Lord; that we are responsible for our doings and ye for yours; and that We are sincere (in our faith) in Him?

002.140 Or do ye say that Abraham, Isma'il Isaac, Jacob and the Tribes were Jews or Christians? Say: Do ye know better than God? Ah! Who is more unjust than those who conceal the testimony they have from God? But God is not unmindful of what ye do!

002.141 That was a people that hath passed away. They shall reap the fruit of what they did, and ye of what ye do! Of their merits there is no question in your case:

002.142 The fools among the people will say: "What hath turned them from the Qibla to which they were used?" Say: To God belong both East and West: He guideth whom He will to a Way that is straight.

002.143 Thus, have We made of you an Ummah justly balanced, that ye might be witnesses over the nations, and the Apostle a witness over yourselves; and We appointed the Qibla to which thou wast used, only to test those who followed the Apostle from those who would turn on their heels (from the Faith). Indeed it was (a change) momentous, except to those guided by God. And never would God make your faith of no effect. For God is to all people most surely full of kindness, Most Merciful.

002.144 We see the turning of thy face (for guidance to the heavens: now shall We turn thee to a Qibla that shall please thee. Turn then Thy face in the direction of the Sacred Mosque: Wherever ye are, turn your faces in that direction. The People of the Book know well that that is the truth from their Lord, Nor is God unmindful of what they do.

002.145 Even if thou wert to bring to the people of the Book all the Signs (together), they would not follow Thy Qibla; nor art thou going to follow their Qibla; nor indeed will they follow each other's Qibla. If thou after the knowledge hath reached thee, Wert to follow their (vain) desires,-then wert thou indeed (clearly) in the wrong.

002.146 The People of the Book know this as they know their own sons; but some of them conceal the truth which they themselves know.

002.147 The Truth is from thy Lord; so be not at all in doubt.

002.148 To each is a goal to which God turns him; then strive together (as in a race) towards all that is good. Wheresoever ye are, God will bring you together. For God Hath power over all things.

002.149 From whencesoever Thou startest forth, turn Thy face in the direction of the Sacred Mosque; that is indeed the truth from your Lord. And God is not unmindful of what ye do.

002.150 So from whencesoever Thou startest forth, turn Thy face in the direction of the Sacred Mosque; and wheresoever ye are, turn your face thither: that there be no ground of dispute against you among the people, except those of them that are bent on wickedness; so fear them not, but fear Me; and that I may complete My favours on you, and ye May (consent to) be guided;

002.151 A similar (favour have ye already received) in that We have sent among you an Apostle of your own, rehearsing to you Our Signs, and purifying you, and instructing you in Scripture and Wisdom, and in new Knowledge.

002.152 Then do ye remember Me; I will remember you. Be grateful to Me, and reject not Faith.

002.153 O ye who believe! Seek help with patient perseverance and prayer; for God is with those who patiently persevere.

002.154 And say not of those who are slain in the way of God: "They are dead." Nay, they are living, though ye perceive (it) not.

002.155 Be sure We shall test you with something of fear and hunger, some loss in goods or lives or the fruits (of your toil), but give glad tidings to those who patiently persevere,

002.156 Who say, when afflicted with calamity: "To God we belong, and to Him is our return":-

002.157 They are those on whom (descend) blessings from their Lord, and Mercy, and they are the ones that receive guidance.

002.158 Behold! Safa and Marwa are among the Symbols of God. So if those who visit the House in the Season or at other times, should compass them round, it is no sin in them. And if any one obeyeth his own impulse to Good,- be sure that God is He Who recogniseth and knoweth.

002.159 Those who conceal the clear (Signs) We have sent down, and the Guidance, after We have made it clear for the People in the Book,-on them shall be God's curse, and the curse of those entitled to curse,-

002.160 Except those who repent and make amends and openly declare (the Truth): To them I turn; for I am Oft-Returning, Most Merciful.

002.161 Those who reject Faith, and die rejecting,- on them is God's curse, and the curse of angels, and of all mankind;

002.162 They will abide therein: Their penalty will not be lightened, nor will respite be their (lot).

002.163 And your God is One God: There is no god but He, Most Gracious, Most Merciful.

002.164 Behold! in the creation of the heavens and the earth; in the alternation of the Night and the Day; in the sailing of the ships through the Ocean for the profit of mankind; in the rain which God sends down from the skies, and the life which He gives therewith to an earth that is dead; in the beasts of all kinds that He scatters through the earth; in the change of the winds, and the clouds which they trail like their slaves between the sky and the earth;- (here) indeed are Signs for a people that are wise.

002.165 Yet there are men who take (for worship) others besides God, as equal (with God): They love them as they should love God. But those of Faith are overflowing in their love for God. If only the unrighteous could see, behold, they would see the Punishment: that to God belongs all power, and God will strongly enforce the Punishment.

002.166 Then would those who are followed clear themselves of those who follow (them): They would see the Penalty, and all relations between them would be cut off.

002.167 And those who followed would say: "If only we had one more chance, we would clear ourselves of them, as they have cleared themselves of us." Thus will God show them (the fruits of) their deeds as (nothing but) regrets. Nor will there be a way for them out of the Fire.

002.168 O ye people! Eat of what is on earth, Lawful and good; and do not follow the footsteps of the Evil One, for he is to you an avowed enemy.

002.169 For he commands you what is evil and shameful, and that ye should say of God that of which ye have no knowledge.

002.170 When it is said to them: "Follow what God hath revealed:" They say: "Nay! we shall follow the ways of our fathers." What! Even though their fathers were void of wisdom and guidance?

002.171 The parable of those who reject Faith is as if one were to shout like a goat- herd, to things that listen to nothing but calls and cries: Deaf, dumb, and blind, they are void of wisdom.

002.172 O ye who believe! Eat of the good things that We have provided for you, and be grateful to God, if it is Him ye worship.

002.173 He hath only forbidden you dead meat, and blood, and the flesh of swine, and that on which any other name hath been invoked besides that of God. But if one is forced by necessity, without wilful disobedience, nor transgressing due limits,- then is he guiltless. For God is Oft-Forgiving Most Merciful.

002.174 Those who conceal God's revelations in the Book, and purchase for them a miserable profit,- they swallow into themselves naught but Fire; God will not address them on the Day of Resurrection, nor purify them: grievous will be their penalty.

002.175 They are the ones who buy Error in place of Guidance and Torment in place of Forgiveness. Ah! what boldness (they show) for the Fire!

002.176 (Their doom is) because God sent down the Book in truth but those who seek causes of dispute in the Book are in a schism far (from the purpose).

002.177 It is not righteousness that ye turn your faces towards East or West; but it is righteousness- to believe in God and the Last Day, and the Angels, and the Book, and the Messengers; to spend of your substance, out of love for Him, for your kin, for orphans, for the needy, for the wayfarer, for those who ask, and for the ransom of slaves; to be steadfast in prayer, and practice regular charity; to fulfil the contracts which ye have made; and to be firm and patient, in pain (or suffering) and adversity, and throughout all periods of panic. Such are the people of truth, the God-fearing.

002.178 O ye who believe! The law of equality is prescribed to you in cases of murder: the free for the free, the slave for the slave, the woman for the woman. But if any remission is made by the brother of the slain, then grant any reasonable demand, and compensate him with handsome gratitude. This is a concession and a Mercy from your Lord. After this whoever exceeds the limits shall be in grave penalty.

002.179 In the Law of Equality there is (saving of) Life to you, o ye men of understanding; that ye may restrain yourselves.

002.180 It is prescribed, when death approaches any of you, if he leave any goods that he make a bequest to parents and next of kin, according to reasonable usage; this is due from the God-fearing.

002.181 If anyone changes the bequest after hearing it, the guilt shall be on those who make the change. For God hears and knows (All things).

002.182 But if anyone fears partiality or wrong-doing on the part of the testator, and makes peace between (the parties concerned), there is no wrong in him: For God is Oft-Forgiving, Most Merciful.

002.183 O ye who believe! Fasting is prescribed to you as it was prescribed to those before you, that ye may (learn) self-restraint,-

002.184 (Fasting) for a fixed number of days; but if any of you is ill, or on a journey, the prescribed number (should be made up) from days later. For those who can do it (with hardship), is a ransom, the feeding of one that is indigent. But he that will give more, of his own free will,- it is better for him. And it is better for you that ye fast, if ye only knew.

002.185 Ramadan is the (month) in which was sent down the Qur'an, as a guide to mankind, also clear (Signs) for guidance and judgment (between right and wrong). So every one of you who is present (at his home) during that month should spend it in fasting, but if any one is ill, or on a journey, the prescribed period (should be made up) by days later. God intends every facility for you; He does not want to put to difficulties. (He wants you) to complete the prescribed period, and to glorify Him in that He has guided you; and perchance ye shall be grateful.

002.186 When My servants ask thee concerning Me, I am indeed close (to them): I listen to the prayer of every suppliant when he calleth on Me: Let them also, with a will, listen to My call, and believe in Me: that they may walk in the right way.

002.187 Permitted to you, on the night of the fasts, is the approach to your wives. They are your garments and ye are their garments. God knoweth what ye used to do secretly among yourselves; but He turned to you and forgave you; so now associate with them, and seek what God Hath ordained for you, and eat and drink, until the white thread of dawn appear to you distinct from its black thread; then complete your fast till the night appears; but do not associate with your wives while ye are in retreat in the mosques. Those are limits (set by) God: Approach not nigh thereto. Thus doth God make clear His Signs to men: that they may learn self-restraint.

002.188 And do not eat up your property among yourselves for vanities, nor use it as bait for the judges, with intent that ye may eat up wrongfully and knowingly a little of (other) people's property.

002.189 They ask thee concerning the New Moons. Say: They are but signs to mark fixed periods of time in (the affairs of) men, and for Pilgrimage. It is no virtue if ye enter your houses from the back: It is virtue if ye fear God. Enter houses through the proper doors: And fear God: That ye may prosper.

002.190 Fight in the cause of God those who fight you, but do not transgress limits; for God loveth not transgressors.

002.191 And slay them wherever ye catch them, and turn them out from where they have turned you out; for tumult and oppression are worse than slaughter; but fight them not at the Sacred Mosque, unless they (first) fight you there; but if they fight you, slay them. Such is the reward of those who suppress faith.

002.192 But if they cease, God is Oft-Forgiving, Most Merciful.

002.193 And fight them on until there is no more tumult or oppression, and there prevail justice and faith in God; but if they cease, let there be no hostility except to those who practise oppression.

002.194 The prohibited month - for the prohibited month, and so for all things prohibited, - there is the law of equality. If then anyone transgresses the prohibition against you, transgress ye likewise against him. But fear God, and know that God is with those who restrain themselves.

002.195 And spend of your substance in the cause of God, and make not your own hands contribute to (your) destruction; but do good; for God loveth those who do good.

002.196 And complete the Hajj or Umra' in the service of God. But if ye are prevented (from completing it), send an offering for sacrifice, such as ye may find, and do not shave your heads until the offering reaches the place of sacrifice. And if any of you is ill, or has an ailment in his scalp, (necessitating shaving), (he should) in compensation either fast, or feed the poor, or offer sacrifice; and when ye are in peaceful conditions (again), if anyone wishes to continue the Umra' on to the Hajj, he must make an offering, such as he can afford, but if he cannot afford it, he should fast three days during the Hajj and seven days on his return, making ten days in all. This is for those whose household is not in (the precincts of) the Sacred Mosque. And fear God, and know that God is strict in punishment.

002.197 For Hajj are the months well known. If any one undertakes that duty therein, let there be no obscenity, nor wickedness, nor wrangling in the Hajj. And whatever good ye do, (be sure) God knoweth it. And take a provision (with you) for the journey, but the best of provisions is right conduct. So fear Me, o ye that are wise.

002.198 It is no crime in you if ye seek of the bounty of your Lord (during pilgrimage). Then when ye pour down from (Mount) 'Arafat, celebrate the praises of God at the Sacred Monument, and celebrate His praises as He has directed you, even though, before this, ye went astray.

002.199 Then pass on at a quick pace from the place whence it is usual for the multitude so to do, and ask for God's forgiveness. For God is Oft-Forgiving, Most Merciful.

002.200 So when ye have accomplished your holy rites, celebrate the praises of God, as ye used to celebrate the praises of your fathers,- yea, with far more heart and soul. There are men who say: "Our Lord! Give us (Thy bounties) in this world!" but they will have no portion in the Hereafter.

002.201 And there are men who say: "Our Lord! Give us good in this world and good in the Hereafter, and defend us from the torment of the Fire!"

002.202 To these will be allotted what they have earned; and God is quick in account.

002.203 Celebrate the praises of God during the Appointed Days. But if anyone hastens to leave in two days, there is no blame on him, and if any one stays on, there is no blame on him, if his aim is to do right. Then fear God, and know that ye will surely be gathered unto Him.

002.204 There is the type of man whose speech about this world's life may dazzle thee, and he calls God to witness about what is in his heart; yet is he the most contentious of enemies.

002.205 When he turns his back, his aim everywhere is to spread mischief through the earth and destroy crops and cattle. But God loveth not mischief.

002.206 When it is said to him, "Fear God", he is led by arrogance to (more) crime. Enough for him is Hell;-An evil bed indeed (to lie on)!

002.207 And there is the type of man who gives his life to earn the pleasure of God: And God is full of kindness to (His) devotees.

002.208 O ye who believe! Enter into Islam whole-heartedly; and follow not the footsteps of the Evil One; for he is to you an avowed enemy.

002.209 If ye backslide after the clear (Signs) have come to you, then know that God is Exalted in Power, Wise.

002.210 Will they wait until God comes to them in canopies of clouds, with angels (in His train) and the question is (thus) settled? But to God do all questions go back (for decision).

002.211 Ask the Children of Israel how many clear (Signs) We have sent them. But if any one, after God's favour has come to him, substitutes (something else), God is strict in punishment.

002.212 The life of this world is alluring to those who reject faith, and they scoff at those who believe. But the righteous will be above them on the Day of Resurrection; for God bestows His abundance without measure on whom He will.

002.213 Mankind was one single nation, and God sent Messengers with glad tidings and warnings; and with them He sent the Book in truth, to judge between people in matters wherein they differed; but the People of the Book, after the clear Signs came to them, did not differ among themselves, except through selfish contumacy. God by His Grace guided the Believers to the Truth, concerning that wherein they differed. For God guided whom He will to a path that is straight.

002.214 Or do ye think that ye shall enter the Garden (of bliss) without such (trials) as came to those who passed away before you? They encountered suffering and adversity, and were so shaken in spirit that even the Apostle and those of faith who were with him cried: "When (will come) the help of God?" Ah! Verily, the help of God is (always) near!

002.215 They ask thee what they should spend (in charity). Say: Whatever ye spend that is good, is for parents and kindred and orphans and those in want and for wayfarers. And whatever ye do that is good, -God knoweth it well.

002.216 Fighting is prescribed for you, and ye dislike it. But it is possible that ye dislike a thing which is good for you, and that ye love a thing which is bad for you. But God knoweth, and ye know not.

002.217 They ask thee concerning fighting in the Prohibited Month. Say: "Fighting therein is a grave (offence); but graver is it in the sight of God to prevent access to the path of God, to deny Him, to prevent access to the Sacred Mosque, and drive out its members." Tumult and oppression are worse than slaughter. Nor will they cease fighting you until they turn you back from your faith if they can. And if any of you turn back from their faith and die in unbelief, their works will bear no fruit in this life and in the Hereafter; they will be Companions of the Fire and will abide therein.

002.218 Those who believed and those who suffered exile and fought (and strove and struggled) in the path of God,- they have the hope of the Mercy of God: And God is Oft-Forgiving, Most Merciful.

002.219 They ask thee concerning wine and gambling. Say: "In them is great sin , and some profit, for men; but the sin is greater than the profit." They ask thee how much they are to spend; Say: "What is beyond your needs." Thus doth God Make clear to you His Signs: In order that ye may consider-

002.220 (Their bearings) on this life and the Hereafter. They ask thee concerning orphans. Say: "The best thing to do is what is for their good; if ye mix their affairs with yours, they are your brethren; but God knows the man who means mischief from the man who means good. And if God had wished, He could have put you into difficulties: He is indeed Exalted in Power, Wise."

002.221 Do not marry unbelieving women (idolaters), until they believe: A slave woman who believes is better than an unbelieving woman, even though she allure you. Nor marry (your girls) to unbelievers until they believe: A man slave who believes is better than an unbeliever, even though he allure you. Unbelievers do (but) beckon you to the Fire. But God beckons by His Grace to the Garden (of Bliss) and forgiveness, and makes His Signs clear to mankind: That they may receive admonition.

002.222 They ask thee concerning women's courses. Say: They are a hurt and a pollution: So keep away from women in their courses, and do not approach them until they are clean. But when they have purified themselves, ye may approach them in any manner, time, or place ordained for you by God. For God loves those who turn to Him constantly and He loves those who keep themselves pure and clean.

002.223 Your wives are as a tilth unto you; so approach your tilth when or how ye will; but do some good act for your souls beforehand; and fear God. And know that ye are to meet Him (in the Hereafter), and give (these) good tidings to those who believe.

002.224 And make not God's (name) an excuse in your oaths against doing good, or acting rightly, or making peace between persons; for God is One Who heareth and knoweth all things.

002.225 God will not call you to account for thoughtlessness in your oaths, but for the intention in your hearts; and He is Oft-Forgiving, Most Forbearing.

002.226 For those who take an oath for abstention from their wives, a waiting for four months is ordained; if then they return, God is Oft-Forgiving, Most Merciful.

002.227 But if their intention is firm for divorce, God heareth and knoweth all things.

002.228 Divorced women shall wait concerning themselves for three monthly periods. Nor is it lawful for them to hide what God Hath created in their wombs, if they have faith in God and the Last Day. And their husbands have the better right to take them back in that period, if they wish for reconciliation. And women shall have rights similar to the rights against them, according to what is equitable; but men have a degree (of advantage) over them. And God is Exalted in Power, Wise.

002.229 A divorce is only permissible twice: after that, the parties should either hold together on equitable terms, or separate with kindness. It is not lawful for you, (men), to take back any of your gifts (from your wives), except when both parties fear that they would be unable to keep the limits ordained by God. If ye (judges) do indeed fear that they would be unable to keep the limits ordained by God, there is no blame on either of them if she give something for her freedom. These are the limits ordained by God; so do not transgress them. If any do transgress the limits ordained by God, such persons wrong (Themselves as well as others).

002.230 So if a husband divorces his wife (irrevocably), he cannot, after that, re-marry her until after she has married another husband and he has divorced her. In that case there is no blame on either of them if they re-unite, provided they feel that they can keep the limits ordained by God. Such are the limits ordained by God, which He makes plain to those who understand.

002.231 When ye divorce women, and they fulfil the term of their ('Iddah), either take them back on equitable terms or set them free on equitable terms; but do not take them back to injure them, (or) to take undue advantage; if any one does that; he wrongs his own soul. Do not treat God's Signs as a jest, but solemnly rehearse God's favours on you, and the fact that He sent down to you the Book and Wisdom, for your instruction. And fear God, and know that God is well acquainted with all things.

002.232 When ye divorce women, and they fulfil the term of their ('Iddah), do not prevent them from marrying their (former) husbands, if they mutually agree on equitable terms. This instruction is for all amongst you, who believe in God and the Last Day. That is (the course making for) most virtue and purity amongst you. And God knows, and ye know not.

002.233 The mothers shall give suck to their offspring for two whole years, if the father desires to complete the term. But he shall bear the cost of their food and clothing on equitable terms. No soul shall have a burden laid on it greater than it can bear. No mother shall be treated unfairly on account of her child. Nor father on account of his child, an heir shall be chargeable in the same way. If they both decide on weaning, by mutual consent, and after due consultation, there is no blame on them. If ye decide on a foster-mother for your offspring, there is no blame on you, provided ye pay (the mother) what ye offered, on equitable terms. But fear God and know that God sees well what ye do.

002.234 If any of you die and leave widows behind, they shall wait concerning themselves four months and ten days: When they have fulfilled their term, there is no blame on you if they dispose of themselves in a just and reasonable manner. And God is well acquainted with what ye do.

002.235 There is no blame on you if ye make an offer of betrothal or hold it in your hearts. God knows that ye cherish them in your hearts: But do not make a secret contract with them except in terms honourable, nor resolve on the tie of marriage till the term prescribed is fulfilled. And know that God Knoweth what is in your hearts, and take heed of Him; and know that God is Oft-Forgiving, Most Forbearing.

002.236 There is no blame on you if ye divorce women before consummation or the fixation of their dower; but bestow on them (a suitable gift), the wealthy according to his means, and the poor according to his means - A gift of a reasonable amount is due from those who wish to do the right thing.

002.237 And if ye divorce them before consummation, but after the fixation of a dower for them, then the half of the dower (is due to them), unless they remit it or (the man's half) is remitted by him in whose hands is the marriage tie; and the remission (of the man's half) is the nearest to righteousness. And do not forget liberality between yourselves. For God sees well all that ye do.

002.238 Guard strictly your (habit of) prayers, especially the Middle Prayer; and stand before God in a devout (frame of mind).

002.239 If ye fear (an enemy), pray on foot, or riding, (as may be most convenient), but when ye are in security, celebrate God's praises in the manner He has taught you, which ye knew not (before).

002.240 Those of you who die and leave widows should bequeath for their widows a year's maintenance and residence; but if they leave (the residence), there is no blame on you for what they do with themselves, provided it is reasonable. And God is Exalted in Power, Wise.

002.241 For divorced women maintenance (should be provided) on a reasonable (scale). This is a duty on the righteous.

002.242 Thus doth God make clear His Signs to you: In order that ye may understand.

002.243 Didst thou not turn by vision to those who abandoned their homes, though they were thousands (in number), for fear of death? God said to them: "Die": Then He restored them to life. For God is full of bounty to mankind, but most of them are ungrateful.

002.244 Then fight in the cause of God, and know that God Heareth and knoweth all things.

002.245 Who is he that will loan to God a beautiful loan, which God will double unto his credit and multiply many times? It is God that giveth (you) Want or Plenty, and to Him shall be your return.

002.246 Hast thou not turned thy vision to the Chiefs of the Children of Israel after (the time of) Moses? They said to a prophet (That was) among them: "Appoint for us a King, that we May fight in the cause of God." He said: "Is it not possible, if ye were commanded to fight, that that ye will not fight?" They said: "How could we refuse to fight in the cause of God, seeing that we were turned out of our homes and our families?" But when they were commanded to fight, they turned back, except a small band among them. But God has full knowledge of those who do wrong.

002.247 Their Prophet said to them: "God hath appointed Talut as King over you." They said: "How can he exercise authority over us when we are better fitted than he to exercise authority, and he is not even gifted, with wealth in abundance?" He said: "God hath Chosen him above you, and hath gifted him abundantly with knowledge and bodily prowess: God Granteth His authority to whom He pleaseth. Allah is All-Embracing, and He knoweth all things."

002.248 And (further) their Prophet said to them: "A Sign of his authority is that there shall come to you the Ark of the Covenant, with (an assurance) therein of security from your Lord, and the relics left by the family of Moses and the family of Aaron, carried by angels. In this is a Symbol for you if ye indeed have faith."

002.249 When Talut set forth with the armies, he said: "God will test you at the stream: if any drinks of its water, he goes not with my army: Only those who taste not of it go with me: A mere sip out of the hand is excused." but they all drank of it, except a few. When they crossed the river,- he and the faithful ones with him,- they said: "This day we cannot cope with Goliath and his forces." But those who were convinced that they must meet God, said: "How oft, by God's will, Hath a small force vanquished a big one? God is with those who steadfastly persevere."

002.250 When they advanced to meet Goliath and his forces, they prayed: "Our Lord! Pour out constancy on us and make our steps firm: Help us against those that reject faith."

002.251 By God's will they routed them; and David slew Goliath; and God gave him power and wisdom and taught him whatever (else) He willed. And did not God check one set of people by means of another, the earth would indeed be full of mischief: But God is full of bounty to all the Worlds.

002.252 These are the Signs of God: We rehearse them to thee in truth: verily Thou art one of the apostles.

002.253 Those apostles We endowed with gifts, some above others: to one of them God spoke; others He raised to degrees (of honour); to Jesus the son of Mary We gave clear (Signs), and strengthened him with the Holy Spirit. If God had so willed, succeeding generations would not have fought among each other, after Clear (Signs) had come to them, but they (chose) to wrangle, some believing and others rejecting. If God had so willed, they would not have fought each other; but God Fulfilleth His plan.

002.254 O ye who believe! Spend out of (the bounties) We have provided for you, before the Day comes when no bargaining (will avail), nor friendship nor intercession. Those who reject Faith they are the wrong-doers.

002.255 God! There is no god but He,-the Living, the Self-subsisting, Eternal. No slumber can seize Him nor sleep. His are all things in the heavens and on earth. Who is there can intercede in His presence except as He permitteth? He knoweth what (appeareth to His creatures as) Before or After or Behind them. Nor shall they compass aught of His knowledge except as He willeth. His Throne doth extend over the heavens and the earth, and He feeleth no fatigue in guarding and preserving them for He is the Most High, the Supreme (in glory).

002.256 Let there be no compulsion in religion: Truth stands out Clear from Error: whoever rejects Evil and believes in God hath grasped the most trustworthy hand-hold, that never breaks. And God heareth and knoweth all things.

002.257 God is the Protector of those who have faith: from the depths of darkness He will lead them forth into light. Of those who reject faith the patrons are the Evil Ones: from light they will lead them forth into the depths of darkness. They will be Companions of the Fire, to dwell therein (forever).

002.258 Hast thou not turned thy vision to one who disputed with Abraham about his Lord, because God had granted him power? Abraham said: "My Lord is He Who Giveth life and death." He said: "I give life and death". Said Abraham: "But it is God that causeth the sun to rise from the East: Do thou then cause him to rise from the West." Thus was he confounded who (in arrogance) rejected faith. Nor doth God Give guidance to a people unjust.

002.259 Or (take) the similitude of one who passed by a hamlet, all in ruins to its roofs. He said: "Oh! how shall God bring it (ever) to life, after (this) its death?" But God caused him to die for a hundred years, then raised him up (again). He said: "How long didst thou tarry (thus)?" He said: (Perhaps) a day or part of a day." He said: "Nay, thou hast tarried thus a hundred years; but look at thy food and thy drink; they show no signs of age; and look at thy donkey: And that We may make of thee a Sign unto the people, Look further at the bones, how We bring them together and clothe them with flesh." When this was shown clearly to him, he said: "I know that God hath power over all things."

002.260 Behold! Abraham said: "My Lord! Show me how Thou givest life to the dead." He said: "Dost thou not then believe?" He said: "Yea! but to satisfy my own undertaking." He said: "Take four birds; Tame them to turn to thee; put a portion of them on every hill and call to them: They will come to thee (flying) with speed. Then know that God is Exalted in Power, Wise."

002.261 The parable of those who spend their substance in the way of God is that of a grain of corn: it groweth seven ears, and each ear Hath a hundred grains. God giveth manifold increase to whom He pleaseth: And God careth for all and He knoweth all things.

002.262 Those who spend their substance in the cause of God, and follow not up their gifts with reminders of their generosity or with injury,-for them their reward is with their Lord: on them shall be no fear, nor shall they grieve.

002.263 Kind words and the covering of faults are better than charity followed by injury. God is free of all wants, and He is Most-Forbearing.

002.264 O ye who believe! cancel not your charity by reminders of your generosity or by injury,- like those who spend their substance to be seen of men, but believe neither in God nor in the Last Day. They are in Parable like a hard, barren rock, on which is a little soil: on it falls heavy rain, which leaves it (just) a bare stone. They will be able to do nothing with aught they have earned. And God guideth not those who reject faith.

002.265 And the likeness of those who spend their substance, seeking to please God and to strengthen their souls, is as a garden, high and fertile: heavy rain falls on it but makes it yield a double increase of harvest, and if it receives not heavy rain, light moisture sufficeth it. God seeth well whatever ye do.

002.266 Does any of you wish that he should have a garden with date-palms and vines and streams flowing underneath, and all kinds of fruit, while he is stricken with old age, and his children are not strong (enough to look after themselves)- that it should be caught in a whirlwind, with fire therein, and be burnt up? Thus doth God make clear to you (His) Signs; that ye may consider.

002.267 O ye who believe! Give of the good things which ye have (honourably) earned, and of the fruits of the earth which We have produced for you, and do not even aim at getting anything which is bad, in order that out of it ye may give away something, when ye yourselves would not receive it except with closed eyes. And know that God is Free of all wants, and worthy of all praise.

002.268 The Evil One threatens you with poverty and bids you to conduct unseemly. God promiseth you His forgiveness and bounties. And God careth for all and He knoweth all things.

002.269 He granteth wisdom to whom He pleaseth; and he to whom wisdom is granted receiveth indeed a benefit overflowing; but none will grasp the Message but men of understanding.

002.270 And whatever ye spend in charity or devotion, be sure God knows it all . But the wrong-doers have no helpers.

002.271 If ye disclose (acts of) charity, even so it is well, but if ye conceal them, and make them reach those (really) in need, that is best for you: It will remove from you some of your (stains of) evil. And God is well acquainted with what ye do.

002.272 It is not required of thee (O Apostle), to set them on the right path, but God sets on the right path whom He pleaseth. Whatever of good ye give benefits your own souls, and ye shall only do so seeking the "Face" of God. Whatever good ye give, shall be rendered back to you, and ye shall not be dealt with unjustly.

002.273 (Charity is) for those in need, who, in God's cause are restricted (from travel), and cannot move about in the land, seeking (for trade or work): the ignorant man thinks, because of their modesty, that they are free from want. Thou shalt know them by their (unfailing) mark: They beg not importunately from all the sundry. And whatever of good ye give, be assured God knoweth it well.

002.274 Those who (in charity) spend of their goods by night and by day, in secret and in public, have their reward with their Lord: on them shall be no fear, nor shall they grieve.

002.275 Those who devour usury will not stand except as stands one whom the Evil One by his touch Hath driven to madness. That is because they say: "Trade is like usury," but God hath permitted trade and forbidden usury. Those who after receiving direction from their Lord, desist, shall be pardoned for the past; their case is for God (to judge); but those who repeat (the offence) are Companions of the Fire: They will abide therein (forever).

002.276 God will deprive usury of all blessing, but will give increase for deeds of charity: For He loveth not creatures ungrateful and wicked.

002.277 Those who believe, and do deeds of righteousness, and establish regular prayers and regular charity, will have their reward with their Lord: on them shall be no fear, nor shall they grieve.

002.278 O ye who believe! Fear God, and give up what remains of your demand for usury, if ye are indeed believers.

002.279 If ye do it not, Take notice of war from God and His Apostle: But if ye turn back, ye shall have your capital sums: Deal not unjustly, and ye shall not be dealt with unjustly.

002.280 If the debtor is in a difficulty, grant him time till it is easy for him to repay. But if ye remit it by way of charity, that is best for you if ye only knew.

002.281 And fear the Day when ye shall be brought back to God. Then shall every soul be paid what it earned, and none shall be dealt with unjustly.

002.282 O ye who believe! When ye deal with each other, in transactions involving future obligations in a fixed period of time, reduce them to writing. Let a scribe write down faithfully as between the parties: let not the scribe refuse to write: as God has taught him, so let him write. Let him who incurs the liability dictate, but let him fear His Lord God, and not diminish aught of what he owes. If the party liable is mentally deficient, or weak, or unable himself to dictate, let his guardian dictate faithfully, And get two witnesses, out of your own men, and if there are not two men, then a man and two women, such as ye choose, for witnesses, so that if one of them errs, the other can remind her. The witnesses should not refuse when they are called on (for evidence). Disdain not to reduce to writing (your contract) for a future period, whether it be small or big: it is juster in the sight of God, more suitable as evidence, and more convenient to prevent doubts among yourselves. But if it be a transaction which ye carry out on the spot among yourselves, there is no blame on you if ye reduce it not to writing. But take witness whenever ye make a commercial contract; and let neither scribe nor witness suffer harm. If ye do (such harm), it would be wickedness in you. So fear God; For it is God that teaches you. And God is well acquainted with all things.

002.283 If ye are on a journey, and cannot find a scribe, a pledge with possession (may serve the purpose). And if one of you deposits a thing on trust with another, let the trustee (faithfully) discharge his trust, and let him fear his Lord. Conceal not evidence; for whoever conceals it,- His heart is tainted with sin. And God Knoweth all that ye do.

002.284 To God belongeth all that is in the heavens and on earth. Whether ye show what is in your minds or conceal it, God Calleth you to account for it. He forgiveth whom He pleaseth, and punisheth whom He pleaseth, for God hath power over all things.

002.285 The Apostle believeth in what hath been revealed to him from his Lord, as do the men of faith. Each one (of them) believeth in God, His angels, His books, and His apostles. "We make no distinction (they say) between one and another of His apostles." And they say: "We hear, and we obey: (We seek) Thy forgiveness, Our Lord, and to Thee is the end of all journeys."

002.286 On no soul doth God place a burden greater than it can bear. It gets every good that it earns, and it suffers every ill that it earns. (Pray): "Our Lord! Condemn us not if we forget or fall into error; Our Lord! Lay not on us a burden like that which Thou didst lay on those before us; Our Lord! Lay not on us a burden greater than we have strength to bear. Blot out our sins, and grant us forgiveness. Have mercy on us. Thou art our Protector; Help us against those who stand against faith."