Gastritis

Question 1

What is gastritis?

Answer 1

Inflammation of the stomach mucosal lining, that is associated with mucosal injury.

Question 2

Name 5 things that can break down the mucin layer in the stomach and cause gastritis.

Answer 2

1. Not enough blood - mucosal ischaemia.
2. H.pylori.
3. Aspirin, NSAIDs e.g. Naproxen
4. Increased acid - stress.
5. Duodenogastric reflux (bile salts)- direct irritant.
6. Alcohol.
7. AI gastritis.

Question 3

Give 4 causes for acute gastritis.

Answer 3

1. Helicobacter pylori infection
2. Alcohol abuse
3. Stress (critically ill, major surgery)
4. NSAIDs (COX inhibitor → inhibits prostaglandin synthesis→ less mucus secretion)

Question 4

Give 2 causes for chronic gastritis.

Answer 4

1. Helicobacter pylori infection
2. Autoimmune gastritis
   - Parietal cell antibodies and intrinsic factor antibodies → reduce vit B12 absorption in terminal ileum → pernicious anaemia

Question 5

What is the most common cause of gastritis?

Answer 5

Helicobacter pylori infection

Question 6

Give 4 signs + symptoms of gastritis.

Answer 6

1. Dyspepsia (indigestion)
2. Epigastric pain
3. Abdominal bloating
4. Nausea + vomiting
5. Anorexia

Question 7

Investigations for gastritis caused by H.pylori infection.

Answer 7

Helicobacter pylori infection
1. Urea breath test
2. Stool antigen test

Before testing, stop PPI for at least 2 weeks; antibiotics for 4 weeks.

Question 8

Investigations for gastritis caused by others, not H.pylori.

Answer 8

1. Endoscopy
   - See gastric mucosal inflammation/atrophy
   - Rugae are more prominent
2. Biopsy
   - Histological assessment
3. Autoimmune (low B12, parietal cell antibodies, intrinsic factor antibodies)

Question 9

Describe the treatment for gastritis.

Answer 9

1. Reduced mucosal ischaemia.
2. PPI.
3. H2RA.
4. Enteric coated aspirin.

Question 10

Management of gastritis.

Answer 10

H.pylori eradication:
= Triple therapy (PPI + 2 antibiotics) = Twice a day for 7 days
1. 1st line: PPI + amoxicillin 1g + clarithromycin 500mg
2. If penicillin allergy: PPI + clarithromycin 500mg + metronidazole 400mg

PPI -> e.g. omeprazole, lansoprazole

NSAIDs, alcohol - stop
Autoimmune - IM vitamin B12 (cyanocobalamin)

Question 11

Give 1 method of prevention for gastritis.

Answer 11

Give PPIs alongside NSAIDs - this also prevents bleeding from acute stress ulcers and gastritis, which is often seen with ill patients - especially burns patients.

Question 12

Differential diagnosis for gastritis.

Answer 12

1. Peptic ulcer disease (PUD)
2. GORD
3. Gastric carcinoma

Question 13

Give 2 complications for gastritis.

Answer 13

1. Peptic ulcers
2. Bleeding and anaemia
3. MALT lymphoma (mucosa-associated lymphoid tissue)
4. Gastric cancer