Gastritis / duodenitis Flashcards
What is gastritis?
Histological diagnosis, although it can be recognised at endoscopy
Describe Acute gastritis?
- Erosive and haemorrhagic
- Predominantly neutrophils in superficial epithelium
Causes of Acute gastritis?
- Injury
- Infection
- Stressors
- Alcohol
- Aspirin
- NSAIDs
- Spicy foods
Symptoms of acute gastritis?
- Often asymptomatic
- Dyspepsia
- Anorexia
- N/V
- Haematemesis/melaena
Investigations in Acute gastritis?
- Usually resolves without investigation
- In some cases, endoscopy and biopsy required to rule out peptic ulcer or cancer
Treatment for acute gastritis?
- Treat underlying cause
- Short term symptomatic therapy
- PPIs
- Prokinetics - domperidone
- Antiemetics - metoclopramide
Describe Domperidone?
- Dopamine antagonist with anti-emetic properties
- SEs: dry mouth, cramps, rash, rarely extrapyramidal effects
Describe Metoclopramide?
- Prokinetic dopamine receptor antagonist
- Prevents N/V
- SEs: Tired, neuroleptic malignant syndrome, depression
What is the most common cause of Chronic gastritis?
Chronic gastritis due to Helicobacter pylori infection
Describe Chronic gastritis due to Helicobacter pylori infection?
- Lymphocytes and plasma cells
- Most patients are asymptomatic and do not require treatment
- Patients with dyspepsia may benefit from H. pylori eradication therapy
Describe Autoimmune chronic gastritis?
- AI damage to parietal cells
- Involves stomach body and spares antrum
- Loss of intrinsic factors leads to pernicious anaemia
- Increased risk of gastric cancer
Histological changes seen in Autoimmune chronic gastritis?
- Diffuse chronic inflammation and atrophy
- Intestinal metaplasia
- Hyperplasia of ECL cells
Describe Menetrier’s disease?
- Gastric pits are elongated and tortuous
- Parietal/chief cells are replaced with mucus-secreting cells
- Excessive production of TGF-a
Describe the presentation of Menetriers disease?
- Most patients are hypochlorhydric
- Upper GI symptoms in some
- Protein-losing enteropathy due to exudation of the gastric mucosa
Treatment of Menetriers disease?
- Antisecretory drugs
- PPIs +/- Octreotide
- H. pylori eradication
- If unresponsive to treatment:
- Partial gastrectomy
How can H. pylori cause gastritis?
- Induces a severe inflammatory response with:
- Gastric mucin degradation
- Increased mucosal permeability
- Followed by gastric epithelial cytotoxicity
How can NSAIDs and alcohol cause gastritis?
- Decrease gastric mucosal blood flow with loss of mucosal protective barrier
- NSAIDs:
- Inhibit prostaglandin production
- Alcohol:
- Depletes sulfhydryl compounds
Read these presentations of gastritis
Primary investigations into gastritis?
- H. pylori urea breath test and faecal antigen test
- Endoscopy:
- Evidence of gastric erosions
- Vitamin B12:
- May be low of AI chronic gastritis
- Parietal cell antibodies
Differentials for Gastritis?
- Peptic ulcer disease
- Endscopy shows presence of peptic ulcer
- GORD
- Specific oesophageal and extra-oesophageal symptoms
- H. pylori breath test negative
Treatment of Autoimmune chronic gastritis?
- Cyanocobalamin
- Vitamin B12 injection
Complications of Gastritis?
- Gastric carcinoma
- Achlorhydria
- Vitamin B12 deficiency
