general medicine

• Gastritis


  Refers to gross mucosal features: erythema, subepithelial hemorrhages, erosions; and pathologic features: histologic inflammation
• Categories of gastritis


  • Acute gastritis
  • Chronic gastritis
  • Specific types of gastritis
• Acute Gastritis (Erosive & Hemorrhagic Gastritis)


  • Aetiology: NSAIDs, aspirin, alcoholic-induced injury, stress-related mucosal injury
• NSAID-induced acute gastritis


  1. Suppression of endogenous prostaglandins

  2. Gastric mucosal barrier damage with back diffusion of acid into the mucosa

  3. Hyperemia, erosions, acute superficial ulceration, subepithelial hemorrhages
• Alcohol-induced acute gastritis


  Lesions similar to acute NSAID-induced lesions: erythema, erosions, subepithelial hemorrhages
• Stress-related mucosal injury


  Stress includes: multiple trauma, sepsis, burns, MOF, prolonged mechanical ventilation, injury of CNS
• Clinical Findings of Acute Gastritis

  • Usually asymptomatic
  • Symptoms: epigastric pain, anorexia, nausea and vomiting, upper gastrointestinal bleeding (hematemesis, melena)
  • Nonspecific laboratory findings: low hematocrit, anemia
• Diagnosis of Acute Gastritis

  Upper endoscopy performed within 24 hours after bleeding to identify the bleeding source
• Differential Diagnosis


  • Peptic ulcer
  • Gastroesophageal reflux (GERD)
  • Gastric cancer
  • Functional dyspepsia
• Treatment of Acute Gastritis

  1. Stop NSAID administration

  2. Use drugs: sucralfate suspension, H2 receptor antagonists (cimetidine, ranitidine, famotidine), proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, rabeprazole)

  3. Usually intravenous infusions to treat severe patients
• Chronic Gastritis


  • Aetiology: Helicobacter pylori (H. pylori)
  • Mechanism of injury: Products of bacterial vacA and cagA genes
  • Prevalence: Less than 10% in the young to over 60% in persons of 60 years of age, correlated with socioeconomic status
  • Pathology: Involving the antrum and body of the stomach, "superficial gastritis" and "atrophic gastritis"
• H. pylori


  Gram-negative, spiral bacteria residing in gastric-type epithelium
• Warren and Marshall awarded Nobel prize

  2005
• Transmission of H. pylori


  Person-to-person by oral-oral or fecal-oral transmission
• Clinical Findings of Chronic Gastritis

  • Majority of infections asymptomatic
  • Dyspeptic symptoms: epigastric pain, anorexia, nausea and vomiting
  • 15% of people with chronic infection have peptic ulcer
  • 2-6 fold increased risk of gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma (MALToma)
• Diagnosis of H. pylori infection

  1. Invasive methods: Gastric mucosal biopsies by endoscopy, rapid urease test, histologic assessment with Warthin-Starry stain, bacterial culture

  2. Noninvasive methods: 14C or 13C urea breath tests, fecal antigen assay, serologic test (IgG antibodies)
• Treatment of H. pylori infection

  H. pylori eradication requiring combination antimicrobial therapy: PPI plus two antibiotics (amoxycillin, clarithromycin, metronidazole, tetracycline) for 10-14 days; or bismuth plus two antibiotics