GASTRITIS Flashcards
Pertinent Anatomy of a patient with Gastritis
Stomach
a condition in which there is epithelial or endothelial damage with histologic
evidence of inflammation.
Gastritis
a condition in which there is epithelial or endothelial damage without
histologic evidence of inflammation.
Gastropathy
Three categories of gastritis
(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
Most commonly seen in alcoholics, critically ill patients (mechanical ventilation, burns, trauma, shock, sepsis, etc.), or patients taking NSAIDs.
Erosive and hemorrhagic “gastritis”
Uncommon causes of Erosive and hemorrhagic “gastritis” include
caustic ingestion and radiation.
Erosive and hemorrhagic gastritis or gastropathy are typically diagnosed at
______, often being performed because of dyspepsia or upper gastrointestinal bleeding
endoscopy
The main types are due to H. pylori infection, pernicious anemia and eosinophilic gastritis.
Non- erosive/non-specific (histologic) gastritis
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.
H pylori
How do you diagnosis H. pylori
1) Histology via Endoscopy (Invasive)
2) Serology (Anti-body)
3) Stool Antigen
4) Urea Breath test
Symptoms of Gastritis and Gastropathy
usually asymptomatic.
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)
25-50%
10- 20%
______ 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)
Excessive alcohol consumption
Differential Diagnosis
(1) Gastroesophageal reflux
(2) Peptic ulcer disease
(3) Gastric cancer
(4) Biliary tract disease
(5) Food poisoning
(6) Viral gastroenteritis
(7) Functional dyspepsia
Differential Diagnosis
With severe pain, one should consider:
(a) Perforated or penetrating ulcer pancreatic disease
(b) Esophageal rupture
(c) Ruptured aortic aneurysm
Differential Diagnosis
Causes of upper gastrointestinal bleeding:
(a) Peptic ulcer disease
(b) Esophageal varices
(c) Mallory-Weiss tear
(d) Boerhaave Syndrome
Lab
(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.
RAD
Upper endoscopy is the most sensitive method of diagnosis
Treatment
(1) NSAID Gastritis
(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.
Treatment
Alcoholic Gastritis
(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
Treatment
Nonerosive, Nonspecific Gastritis
(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.
Treatment
Stress Gastritis
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
Treatment
Portal Hypertensive Gastropathy
(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).
