Gastritis

Question 1

Causes of gastritis (8) (STARSHIP)

Answer 1

1. Stress - gastric hyperacidity
2. Trauma - NG tube
3. Autoimmune - pernicious anaemia, Crohn’s
4. Radiation
5. Surgery - gastric banding
6. H. pylori and other infections
7. Irritants - NSAIDs, caffeine, alcohol, vomiting, smoking
8. Pyloric dysfunction - post-op

Question 2

Pathology of gastritis (3 steps)

Answer 2

1. Damage to gastric glands
2. Atrophic gastritis (wasting of gastric glands)
3. Mucous gland metaplasia (replacement by mucous glands)

This can either result in complete metaplasia (gastric mucosa resembles small bowel functionally and histologically) or incomplete metaplasia (gastric mucosa resembles large bowel and frequently exhibits dysplasia)

Question 3

Clinical presentation of gastritis (6)

Answer 3

1. Abdominal pain (burning epigastric pain, very variable)
2. Nausea / vomiting / LOA
3. Heartburn
4. Bloating
5. Hiccups
6. Early satiety / post-prandial fullness

Question 4

Investigations for gastritis (5)

Answer 4

1. FBE (WCC, anaemia)
2. Lipase (pancreatitis)
3. B12, parietal cell abs, IF abs (pernicious anaemia)
4. H. pylori urea breath test (>95% sensitive)
5. Endoscopy (thick folds, inflammatory nodules, coarse area gastrica, erosions) ENTICE

Question 5

Treatment for erosive gastritis

Answer 5

Stop agent exposure (e.g. NSAIDs) + H2 antagonist / PPI

Question 6

Triple therapy for H pylori infection

Answer 6

1. PPI (oesomeprazole or omeprazole) 2. Clarythromycin 3. Amoxycillin OR metronidazole 4. Bismuth (quadruple therapy)

Question 7

Treatment for pernicious anaemia

Answer 7

Cyanocoblamin (vitamin B12)

Question 8

Complications of gastritis (3)

Answer 8

1. PUD, bleeding
2. Gastric carcinoma, gastric lymphoma
3. Chornic atrophic gastritis → achlorhydria and impaired absorption of B12, iron and calcium