GASTRITIS

Question 1

Pertinent Anatomy of a patient with Gastritis

Answer 1

Stomach

Question 2

a condition in which there is epithelial or endothelial damage with histologic
evidence of inflammation.

Answer 2

Gastritis

Question 3

a condition in which there is epithelial or endothelial damage without
histologic evidence of inflammation.

Answer 3

Gastropathy

Question 4

Three categories of gastritis

Answer 4

(a) Erosive and hemorrhagic “gastritis”
(b) Nonerosive, nonspecific (histologic) gastritis
(c) Specific types of gastritis, characterized by distinctive histologic and endoscopic features diagnostic of specific disorders

Question 5

Most commonly seen in alcoholics, critically ill patients (mechanical ventilation, burns, trauma, shock, sepsis, etc.), or patients taking NSAIDs.

Answer 5

Erosive and hemorrhagic “gastritis”

Question 6

Uncommon causes of Erosive and hemorrhagic “gastritis” include

Answer 6

caustic ingestion and radiation.

Question 7

Erosive and hemorrhagic gastritis or gastropathy are typically diagnosed at
______, often being performed because of dyspepsia or upper gastrointestinal bleeding

Answer 7

endoscopy

Question 8

The main types are due to H. pylori infection, pernicious anemia and eosinophilic gastritis.

Answer 8

Non- erosive/non-specific (histologic) gastritis

Question 9

a spiral gram-negative rod that resides beneath the gastric mucous layer
adjacent to gastric epithelial cells. Although not invasive, it causes gastric mucosal inflammation with PMNs and lymphocytes.

Answer 9

H pylori

Question 10

How do you diagnosis H. pylori

Answer 10

1) Histology via Endoscopy (Invasive)
2) Serology (Anti-body)
3) Stool Antigen
4) Urea Breath test

Question 11

Symptoms of Gastritis and Gastropathy

Answer 11

usually asymptomatic.

Question 12

Of patients receiving NSAIDs in clinical trials, ______ have gastritis and ____ have ulcers at endoscopy; however, symptoms of significant dyspepsia
develop in about 5%
(Gastritis and Gastropathy)

Answer 12

25-50%

10- 20%

Question 13

______ may lead to dyspepsia, nausea, emesis, and minor hematemesis, a condition sometimes labeled “alcoholic gastritis.” However, it is not proven that alcohol alone actually causes significant
erosive gastritis.
(Gastritis and Gastropathy)

Answer 13

Excessive alcohol consumption

Question 14

Differential Diagnosis

Answer 14

(1) Gastroesophageal reflux
(2) Peptic ulcer disease
(3) Gastric cancer
(4) Biliary tract disease
(5) Food poisoning
(6) Viral gastroenteritis
(7) Functional dyspepsia

Question 15

Differential Diagnosis

With severe pain, one should consider:

Answer 15

(a) Perforated or penetrating ulcer pancreatic disease
(b) Esophageal rupture
(c) Ruptured aortic aneurysm

Question 16

Differential Diagnosis

Causes of upper gastrointestinal bleeding:

Answer 16

(a) Peptic ulcer disease
(b) Esophageal varices
(c) Mallory-Weiss tear
(d) Boerhaave Syndrome

Question 17

Lab

Answer 17

(1) nonspecific
(2) The hematocrit may be low if significant bleeding has occurred.
(3) Iron deficiency may be found in chronic cases.
(4) In patients where H. pylori infection is suspected, noninvasive testing for H. Pylori (quantitative serologic ELISA tests) may be indicated
(5) Biopsies may also help diagnose certain specific causes like H. pylori.

Question 18

RAD

Answer 18

Upper endoscopy is the most sensitive method of diagnosis

Question 19

Treatment

(1) NSAID Gastritis

Answer 19

(a) Given the frequency of dyspeptic symptoms in patients taking NSAIDs, it is neither feasible nor desirable to investigate all such cases
(b) Patients with alarm symptoms or signs, such as severe pain, weight loss,
vomiting, gastrointestinal bleeding, or anemia, should undergo diagnostic
upper endoscopy.
(c) For other patients, symptoms may improve with discontinuation of the agent,
reduction to the lowest effective dose, or administration with meals.
(d) Proton pump inhibitors have demonstrated efficacy in controlled trials for the treatment NSAID-related dyspepsia.
1) Although superiority to H2- receptor antagonists for relief of NSAID- related
dyspepsia has not been established, proton pump inhibitors have demonstrated superiority for healing of NSAID- related ulcers in the setting of continued NSAID use.
2) Therefore, an empiric 2-4 week trial of an oral proton pump inhibitor (PPI) is
recommended for patients with NSAID-related dyspepsia, especially those in
whom continued NSAID treatment is required.
3) If symptoms do not improve, diagnostic upper endoscopy should be conducted.

Question 20

Treatment

Alcoholic Gastritis

Answer 20

(a) Discontinue alcohol use
(b) Therapy with H2- receptor antagonists (e.g. Zantac), proton pump inhibitors
(e. g. Omeprazole), or sucralfate for 2-4 weeks often is empirically prescribed.
(c) Sucralfate (Carafate) - Gastric cytoprotectant
1) Dose: 1-gram PO qid

Question 21

Treatment

Nonerosive, Nonspecific Gastritis

Answer 21

(a) Helicobacter pylori Gastritis: Triple or quadruple therapy is indicated to relieve symptoms and eradicate H. pylori infection. Options include:
1) Proton pump inhibitor orally twice daily PLUS Clarithromycin 500 mg orally
twice daily PLUS Amoxicillin 1 g orally twice daily (OR metronidazole 500 mg
orally twice daily, if penicillin allergic)
2) Proton pump inhibitor orally twice daily PLUS Bismuth subsalicylate two tablets orally four times daily PLUS Tetracycline 500 mg orally four times daily PLUS Metronidazole 250 mg orally four times daily.
3) Proton pump inhibitor orally twice daily PLUS Days 1-5: amoxicillin 1 g orally
twice daily PLUS Days 6-10: clarithromycin 500 mg and metronidazole 500 mg, both orally twice daily.

Question 22

Treatment

Stress Gastritis

Answer 22

Treatment: bleeding occurs, patients should receive continuous infusions of a
proton pump inhibitor (esomeprazole or pantoprazole, 80 mg intravenous bolus, followed by 8 mg/h continuous infusion) as well as sucralfate suspension

Question 23

Treatment

Portal Hypertensive Gastropathy

Answer 23

(a) Portal hypertension commonly results in gastric mucosal and submucosal
congestion of capillaries and venules, which is correlated with the severity of
the portal hypertension and underlying liver disease.
(b) Treatment with propranolol or nadolol reduces the incidence of recurrent
acute bleeding by lowering portal pressures.
(c) Patients who fail propranolol therapy may be successfully treated with portal
decompressive procedures (see section on treatment of esophageal varices).