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gastritis
Inflammation of the gastric mucosa.
Etiology:
1) Bacterial
- Helicobacter pylori
- accounts for 80% of chronic gastritis
- may progress to peptic ulcer disease or gastric carcinoma
- secondary & tertiary syphilis
- Mycobacterium species
- Clostridium
- Escherichia coli
- Streptococcus
- Staphylococcus
- Proteus
2) Viral
- Cytomegalovirus
- Herpesvirus
3) Fungi generally in immunocompromised hosts
- Candida
- Histoplasmosis
- Mucormycosis
4) parasitic generally in immunocompromised hosts
- Strongyloides stercoralis (rarely affects stomach)
- Anisakiasis
5) non-infectious granulomatous gastritis
- Crohn's disease - uncommon
- sarcoidosis: GI infrequently involved, but stomach is most frequent site of GI involvement
- eosinophilic granulomatosus
- eosinophilic infiltration, wall thickening, fibrosis
6) pharmacologic agents: NSAIDs
7) toxins
- alcohol
- corrosive chemicals: scarring, obstruction
8) autoimmune disease
- 20% of patients with autoimmune gastritis have pernicious anemia
- parietal cell & intrinsic factor autoantibodies
- hypergastrinemia
- hypo or achlorhydria
- genetic link with autosomal dominant inheritance
9) stress-induced
- 80-100% of critically ill patients
- multiple shallow erosions of proximal stomach
10) reflux of alkaline secretions from the duodenum
- occurs in patients with surgery affecting the pyloric sphincter, i.e. Billroth II
- mechanism may involve toxicity of bile or pancreatic enzymes to gastric mucosa
11) irradiation: 1600 rads can produce significant gastritis
12) gastric ischemia
13) Menetrier's disease
14) gastric antral vascular ectasia
15) Zollinger-Ellison syndrome
Pathology:
- intestinal metaplasia is less common in H pylori-negative versus H pylori-positive gastritis (6.1% vs. 13.0%) [3]
Clinical manifestations:
1) chronic gastritis is frequently asymptomatic
2) symptoms of acute gastritis are generally mild
3) epigastric pain & tenderness
4) nausea/vomiting - hematemesis
5) hypersalivation
6) bloat
Laboratory:
- serum chemistries
a) vitamin B12
b) gastrin
Special laboratory:
1) endoscopy with biopsy
2) nasogastric aspirate
3) CLO test
Radiology:
- upper GI series
Differential diagnosis:
1) peptic ulcer disease (PUD)
2) dyspepsia without ulceration
3) gastroparesis
4) gastric carcinoma
5) lymphoma
6) gastroesophageal reflux disease (GERD)
7) pancreatitis
Management:
1) discontinuation of offending agents
a) NSAIDs
b) spicy foods
c) alcohol
d) tobacco
2) treatment of specific etiologies, especially H. pylori
3) control hemorrhage
4) prevention of acidification
a) H2-receptor antagonists
b) proton pump inhibitors
c) sucralfate (Carafate)
5) patient education
a) chronic gastritis increases the risk of peptic ulcer disease (PUD)
b) atrophic gastritis is associated with an increased risk of gastric cancer
6) after resolution of NSAID-induced gastritis, a trial of administration of NSAID with misoprostol may be indicated
Related
Helicobacter pylori
Specific
atrophic gastritis
eosinophilic gastritis
gastric antral vascular ectasia
lymphocytic gastritis
Menetrier's disease
NSAID gastropathy
General
gastric disease
inflammation
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 327-29
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Genta RM and Sonnenberg A.
Helicobacter-negative gastritis: A distinct entity unrelated
to H. pylori infection.
Aliment Pharmacol Ther 2014 Nov 6
http://onlinelibrary.wiley.com/doi/10.1111/apt.13007/abstract
- Gastritis & Gastropathy
https://www.niddk.nih.gov/health-information/digestive-diseases/gastritis-gastropathy