Gastritis Flashcards
What does the term gastritis refer to?
Histologically documented inflammation of the gastric mucosa
Gastritis is not synonymous with mucosal erythema seen during endoscopy or with dyspepsia.
Is gastritis interchangeable with dyspepsia?
No
Gastritis specifically refers to inflammation of the gastric mucosa, while dyspepsia is a broader term for digestive discomfort.
Fill in the blank: Gastritis is classified based on _______ features.
[histologic]
What are the two main types of gastritis based on time course?
Acute and chronic
These classifications help in understanding the duration and potential treatment of gastritis.
What are the most common causes of acute gastritis?
Infectious causes, primarily H. pylori infection
Acute infection with H. pylori induces gastritis, though it has not been extensively studied.
What are the symptoms of acute H. pylori gastritis?
Sudden onset of epigastric pain, nausea, and vomiting
Limited mucosal histologic studies show marked infiltrate of neutrophils with edema and hyperemia.
What could happen if acute gastritis is not treated?
It may evolve into chronic gastritis
Hypochlorhydria lasting for up to 1 year may follow acute H. pylori infection.
What is phlegmonous gastritis?
A rare, potentially life-threatening disorder characterized by marked and diffuse acute inflammatory infiltrates of the entire gastric wall
It may be accompanied by necrosis.
Which individuals are at risk for phlegmonous gastritis?
Elderly individuals, alcoholics, and AIDS patients
Potential iatrogenic causes include polypectomy and mucosal injection with India ink.
What organisms are associated with phlegmonous gastritis?
- Streptococci
- Staphylococci
- Escherichia coli
- Proteus
- Haemophilus species
Failure of supportive measures and antibiotics may result in gastrectomy.
What types of gastritis may occur in immunocompromised individuals?
Herpetic (herpes simplex) or CMV gastritis
Histologic findings of intranuclear inclusions would be observed in CMV gastritis.
What is chronic gastritis primarily characterized by histologically?
An inflammatory cell infiltrate consisting primarily of lymphocytes and plasma cells
Very scant neutrophil involvement is also noted.
What are the initial areas affected by the inflammation in chronic gastritis?
Superficial and glandular portions of the gastric mucosa
The inflammation may be patchy in distribution.
What can chronic gastritis progress to in terms of glandular destruction?
Atrophy and metaplasia
What histologic characteristics classify chronic gastritis?
Superficial atrophic changes and gastric atrophy
What is the association of atrophic gastritis with gastric cancer?
It has led to the development of endoscopic and serologic markers of severity.
List some tools used for assessing chronic gastritis severity.
- Gross inspection during endoscopy
- Magnification endoscopy
- Endoscopy with narrow band imaging
- Autofluorescence imaging
- Measurement of serum biomarkers (pepsinogen I and II levels, gastrin-17, anti–H. pylori serologies)
What is the early phase of chronic gastritis called?
Superficial gastritis
What are the characteristics of superficial gastritis?
Inflammatory changes are limited to the lamina propria of the surface mucosa, with edema and cellular infiltrates separating intact gastric glands.
What follows superficial gastritis in the progression of chronic gastritis?
Atrophic gastritis
What occurs during the atrophic gastritis stage?
The inflammatory infiltrate extends deeper into the mucosa, leading to distortion and destruction of the glands.
What is the final stage of chronic gastritis?
Gastric atrophy
What happens to glandular structures during gastric atrophy?
Glandular structures are lost, and there is a paucity of inflammatory infiltrates.
What can be observed endoscopically in gastric atrophy?
The mucosa may be substantially thin, permitting clear visualization of the underlying blood vessels.
What is intestinal metaplasia in the context of chronic gastritis?
The conversion of gastric glands to a small intestinal phenotype with small-bowel mucosal glands containing goblet cells.
What is a significant risk factor for gastric cancer?
Intestinal metaplasia
How is chronic gastritis classified according to predominant site of involvement?
- Type A: body-predominant form (autoimmune)
- Type B: antral-predominant form (H. pylori–related)
What does AB gastritis refer to?
A mixed antral/body picture
True or False: Chronic gastritis can be classified based on histologic characteristics.
True
Fill in the blank: The inflammatory infiltrate in atrophic gastritis extends _______ into the mucosa.
deeper
What is Type A gastritis primarily associated with?
Pernicious anemia
Type A gastritis is also known as autoimmune gastritis.
Which areas of the stomach does Type A gastritis primarily involve?
Fundus and body
It involves antral sparing.
What type of antibodies are associated with Type A gastritis?
Antibodies against parietal cells and intrinsic factor (IF)
These antibodies are found in patients with pernicious anemia.
What is the prevalence of parietal cell antibodies in patients with pernicious anemia?
> 90%
Up to 50% of patients with type A gastritis may also have these antibodies.
What is the mechanism thought to be involved in the injury pattern of Type A gastritis?
Molecular mimicry
This involves mimicry between H. pylori LPS and H+ ,K+ -ATPase.
What specific gastric cell type is targeted in Type A gastritis?
Parietal cells
This leads to achlorhydria.
What is a consequence of the lack of intrinsic factor (IF) in Type A gastritis?
Vitamin B12 deficiency
This can lead to megaloblastic anemia and neurologic dysfunction.
What happens to gastrin levels in patients with achlorhydria?
Elevated gastrin levels
Levels can exceed 500 pg/mL in patients with pernicious anemia.
Which familial histocompatibility haplotypes are associated with autoimmune gastritis?
HLA-B8 and HLA-DR3
These haplotypes indicate a genetic predisposition.
What is the significance of low pepsinogen levels in Type A gastritis?
It serves as a diagnostic tool
Low pepsinogen levels are indicative of autoimmune gastritis.
True or False: Hypergastrinemia can occur in non-pernicious anemia associated Type A gastritis.
True
Achlorhydria and hypergastrinemia are common in both types.
What potential tumor development can result from ECL cell hyperplasia due to gastrin trophic effects?
Gastric carcinoid tumors
This occurs as a consequence of elevated gastrin levels.
What percentage of individuals aged over 60 may have parietal cell antibodies?
~20%
This prevalence is notable in older populations.
Fill in the blank: Type A gastritis is also called _______.
autoimmune gastritis
What is the role of gastric acid in relation to gastrin release?
Feedback inhibition
Gastric acid inhibits gastrin release from G cells.
