Gastritis / duodenitis

Question 1

What is gastritis?

Answer 1

Histological diagnosis, although it can be recognised at endoscopy

Question 2

Describe Acute gastritis?

Answer 2

• Erosive and haemorrhagic
• Predominantly neutrophils in superficial epithelium

Question 3

Causes of Acute gastritis?

Answer 3

• Injury
• Infection
• Stressors
• Alcohol
• Aspirin
• NSAIDs
• Spicy foods

Question 4

Symptoms of acute gastritis?

Answer 4

• Often asymptomatic
• Dyspepsia
• Anorexia
• N/V
• Haematemesis/melaena

Question 5

Investigations in Acute gastritis?

Answer 5

• Usually resolves without investigation
• In some cases, endoscopy and biopsy required to rule out peptic ulcer or cancer

Question 6

Treatment for acute gastritis?

Answer 6

• Treat underlying cause
• Short term symptomatic therapy
  
  • PPIs
  • Prokinetics - domperidone
  • Antiemetics - metoclopramide

Question 7

Describe Domperidone?

Answer 7

• Dopamine antagonist with anti-emetic properties
• SEs: dry mouth, cramps, rash, rarely extrapyramidal effects

Question 8

Describe Metoclopramide?

Answer 8

• Prokinetic dopamine receptor antagonist
• Prevents N/V
• SEs: Tired, neuroleptic malignant syndrome, depression

Question 9

What is the most common cause of Chronic gastritis?

Answer 9

Chronic gastritis due to Helicobacter pylori infection

Question 10

Describe Chronic gastritis due to Helicobacter pylori infection?

Answer 10

• Lymphocytes and plasma cells
• Most patients are asymptomatic and do not require treatment
• Patients with dyspepsia may benefit from H. pylori eradication therapy

Question 11

Describe Autoimmune chronic gastritis?

Answer 11

• AI damage to parietal cells
• Involves stomach body and spares antrum
• Loss of intrinsic factors leads to pernicious anaemia
• Increased risk of gastric cancer

Question 12

Histological changes seen in Autoimmune chronic gastritis?

Answer 12

• Diffuse chronic inflammation and atrophy
• Intestinal metaplasia
• Hyperplasia of ECL cells

Question 13

Describe Menetrier’s disease?

Answer 13

• Gastric pits are elongated and tortuous
• Parietal/chief cells are replaced with mucus-secreting cells
• Excessive production of TGF-a

Question 14

Describe the presentation of Menetriers disease?

Answer 14

• Most patients are hypochlorhydric
  
  • Upper GI symptoms in some
• Protein-losing enteropathy due to exudation of the gastric mucosa

Question 15

Treatment of Menetriers disease?

Answer 15

• Antisecretory drugs
  
  • PPIs +/- Octreotide
• H. pylori eradication
• If unresponsive to treatment:
  
  • Partial gastrectomy

Question 16

How can H. pylori cause gastritis?

Answer 16

• Induces a severe inflammatory response with:
  
  • Gastric mucin degradation
  • Increased mucosal permeability
• Followed by gastric epithelial cytotoxicity

Question 17

How can NSAIDs and alcohol cause gastritis?

Answer 17

• Decrease gastric mucosal blood flow with loss of mucosal protective barrier
• NSAIDs:
  
  • Inhibit prostaglandin production
• Alcohol:
  
  • Depletes sulfhydryl compounds

Question 18

Read these presentations of gastritis

Answer 18

Question 19

Primary investigations into gastritis?

Answer 19

• 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

Question 20

Differentials for Gastritis?

Answer 20

• Peptic ulcer disease
  
  • Endscopy shows presence of peptic ulcer
• GORD
  
  • Specific oesophageal and extra-oesophageal symptoms
  • H. pylori breath test negative

Question 21

Treatment of Autoimmune chronic gastritis?

Answer 21

• Cyanocobalamin
  
  • Vitamin B12 injection

Question 22

Complications of Gastritis?

Answer 22

• Gastric carcinoma
• Achlorhydria
• Vitamin B12 deficiency