gastritis
Jump to navigation
Jump to search
Introduction
Inflammation of the gastric mucosa.
Etiology
- 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
- Helicobacter pylori
- Viral
- Fungi generally in immunocompromised hosts
- parasitic generally in immunocompromised hosts
- Strongyloides stercoralis (rarely affects stomach)
- Anisakiasis
- 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
- pharmacologic agents: NSAIDs
- toxins
- 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
- stress-induced
- 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
- irradiation: 1600 rads can produce significant gastritis
- gastric ischemia
- Menetrier's disease
- gastric antral vascular ectasia
- 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
- chronic gastritis is frequently asymptomatic
- symptoms of acute gastritis are generally mild
- epigastric pain & tenderness
- nausea/vomiting - hematemesis
- hypersalivation
- bloat
Laboratory
Diagnostic procedures
- endoscopy with biopsy
- nasogastric aspirate
- CLO test
Radiology
Differential diagnosis
- peptic ulcer disease (PUD)
- dyspepsia without ulceration
- gastroparesis
- gastric carcinoma
- lymphoma
- gastroesophageal reflux disease (GERD)
- pancreatitis
Management
- discontinuation of offending agents
- treatment of specific etiologies, especially H. pylori
- control hemorrhage
- prevention of acidification
- patient education
- chronic gastritis increases the risk of peptic ulcer disease (PUD)
- atrophic gastritis is associated with an increased risk of gastric cancer
- after resolution of NSAID-induced gastritis, a trial of administration of NSAID with misoprostol may be indicated
More general terms
More specific terms
- atrophic gastritis
- eosinophilic gastritis
- gastric antral vascular ectasia
- lymphocytic gastritis
- Menetrier's disease
- NSAID gastropathy
Additional terms
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
- ↑ 3.0 3.1 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