STOMACH

• Diseases of the stomach and duodenum

  • Gastritis
  • Gastropathy
  • Helicobacter pylori (H. pylori) infection
  • Peptic ulcer disease
  • Gastric intestinal metaplasia
• Gastritis


  Inflammation of the stomach lining with multiple etiologies including autoimmune mechanisms, viral infections, and H. pylori infection
• Gastritis manifestations

  Clinical signs of inflammation including mucosal injury, atrophy, and parietal cell loss
• In severe cases, gastritis can contribute to vitamin B12 deficiency, resulting in pernicious anemia
• Complications of gastritis may include gastric intestinal metaplasia, characterized by the transformation of gastric epithelium into intestinal-like tissue
• Gastropathy

  Damage to the stomach lining without significant inflammation, characterized by epithelial cell damage and regeneration
• Etiologies of Gastropathy

  • Exposure to irritants such as NSAIDs, certain medications, alcohol, bile reflux, chronic congestion, stress ulcers, trauma, shock, renal failure, and portal hypertension
• Gastropathy vs. Gastritis

  Gastropathy involves epithelial cell damage and regeneration without significant inflammation, unlike gastritis
• Treatment strategies for stomach and duodenum diseases may vary depending on the underlying cause and severity of the disease
• H. pylori infection plays a major role in gastritis and peptic ulcer disease
• H. pylori infection

  A slow-growing, spiral-shaped bacterium that is Gram-negative, flagellated, and urease-producing, colonizing the gastric mucosa
• Risk factors for acquiring H. pylori infection

  • Living in developing countries, crowded living conditions, poor sanitation, and low socioeconomic status
• H. pylori-related diseases

  • Antral gastritis
  • Peptic ulcers (gastric and duodenal)
  • Gastric cancer
• Pathogenesis of H. pylori infection

  Colonization of the gastric mucosa, release of cytotoxic enzymes, and induction of inflammation
• Pathophysiology of H. pylori-related diseases

  Includes antral gastritis, hypergastrinemia, increased acid secretion, pangastritis, parietal cell loss, and reduced gastric mucosal resistance
• Clinical signs of H. pylori infection include dyspepsia, epigastric pain, and hematemesis
• Complications of H. pylori-related diseases can be severe and may include hemorrhage, perforation, and gastric outlet obstruction
• Diagnosis of H. pylori infection

  Non-invasive methods such as urea breath tests, stool antigen tests, serology, and invasive methods like endoscopic biopsy with histological examination using Giemsa staining
• Differential diagnosis for H. pylori-related diseases

  • Gastritis
  • Peptic ulcer disease
  • GERD
  • Gastric malignancies
• Treatment of H. pylori infection

  Usually involves antibiotic therapy with common regimens including triple therapy or quadruple therapy
• Treatment of H. pylori infection

  1. Usually involves antibiotic therapy

  2. Common regimens include triple therapy (a proton pump inhibitor (PPI) plus clarithromycin and either amoxicillin or metronidazole) or quadruple therapy (a PPI plus bismuth subsalicylate, metronidazole, and tetracycline)
• Early detection and appropriate management of H. pylori infection are essential to prevent complications and improve patient outcomes
• Risk factors for peptic ulcers

  • Helicobacter pylori (H. pylori) infection
  • NSAID use
  • Smoking
  • Alcohol consumption
  • Stress
• Pathogenesis of peptic ulcers

  • H. pylori infection causes inflammation and mucosal damage
  • NSAIDs impair mucosal defense mechanisms, leading to ulcer formation
• Pathophysiology of peptic ulcers

  • Results from an imbalance between aggressive factors such as acid and pepsin and protective mechanisms like mucosal integrity and bicarbonate secretion
• Clinical signs of peptic ulcers

  • Recurrent, burning epigastric pain
  • Nausea
  • Vomiting
  • Anorexia
  • Weight loss
• Complications of peptic ulcers

  May include hemorrhage, perforation, and gastric outlet obstruction
• Diagnosis of peptic ulcers

  Often involves urea breath tests, stool antigen tests, serology, and endoscopic biopsy with histological examination using Giemsa stain
• Differential diagnosis for peptic ulcers

  • Gastroesophageal reflux disease (GERD)
  • Biliary colic
  • Pancreatic disorders
• Management of peptic ulcers

  1. Includes eradication of H. pylori infection, acid suppression therapy, and lifestyle modifications

  2. Treatment typically involves antibiotic therapy, such as triple or quadruple therapy
• Management of gastroparesis

  1. Focuses on lifestyle modifications, including avoiding large meals, eating slowly, chewing food thoroughly, staying hydrated, and engaging in stress-reducing activities

  2. Treatment options may include medication therapy, including promotility agents such as metoclopramide and domperidone, as well as antiemetics like ondansetron to alleviate symptoms of nausea and vomiting
• Dyspepsia, often referred to as "indigestion," is another common gastrointestinal condition
• Management of gastroparesis

  1. Lifestyle modifications such as chewing food thoroughly, staying hydrated, and engaging in stress-reducing activities

  2. Medication therapy including promotility agents like metoclopramide and domperidone, as well as antiemetics like ondansetron to alleviate symptoms of nausea and vomiting
• Dyspepsia is often referred to as "indigestion" and is a common gastrointestinal disorder characterized by upper abdominal symptoms such as heartburn, acidity, pain or discomfort, nausea, wind, fullness, or belching
• Etiology of dyspepsia

  Multifactorial, with risk factors including diet, stress, and smoking
• Classification of dyspepsia

  • Functional dyspepsia (no identifiable cause)
  • Organic dyspepsia (symptoms attributed to an underlying condition)
• Diagnosis of dyspepsia

  Typically involves upper endoscopy, imaging studies, or laboratory tests to rule out other gastrointestinal conditions such as GERD, peptic ulcer disease, gastritis, gallbladder disease, and irritable bowel syndrome (IBS)
• Management of dyspepsia

  Lifestyle modifications such as dietary changes, stress management, and medication therapy to reduce stomach acid production and alleviate symptoms
• Treatment options for dyspepsia

  May include medications such as antacids and prokinetic agents to promote gastric emptying and improve digestion
• Diseases of the stomach and duodenum encompass a range of conditions that affect the upper gastrointestinal tract