Gastritis & GORD Flashcards
Define gastritis
Inflammation of the stomach mucosal lining
Gastritis classifications
- Antral or pangastritis
- Acute or chronic gastritis
- Erosive or non-erosive
RFs for Gasritis
ALCOHOL
NSAIDs
HPylori
HLA-DR3 B8
Granulomas
Acute gastritis
inflammation of the gastric mucosa
Chronic gastritis
chronic inflammation of gastric mucosa → epithelial metaplasia, mucosal atrophy and gland loss. Metaplasia may also lead to dysplasia and so there is risk of cancer.
Aetiology of acute gastritis
Helicobacter pylori
Alcohol abuse
Stress
NSAIDs
Aetiology of chronic gastritis
H pylori 80%
Autoimmune gastritis
How does H pylori cause gastritis
- Causes severe inflammatory response
- Gastric mucus degradation and increased mucosal permeability, which is directly cytotoxic to the gastric epithelium: since H.pylori produces urease which converts urea to ammonia and CO2 which is toxic since ammonia and H+ (from HCl) form ammonium which damages gastric mucosa resulting in less mucous production.
What are the different types of gastritis
Type a -autoimmune
Type b- antral gastritis - h pylori
Reflux gastritis- bile refluxes into stomach
Erosive- due to nsaids
Stress ulceration- a result of mucosal ischaemia
Explain the background of autoimmune chronic gastritis
Parietal cell antibodies
and intrinsic factor antibodies in fundus and body of stomach → reduce vit B12 absorption in terminal ileum → pernicious anaemia
How doe NSAIDs like naproxen cause gastritis
Inhibit prostaglandins (which stimulate mucus production) via the inhibition of cyclo-oxygenase resulting in less mucus production and thus gastritis
Signs and symptoms of gastritis
Dyspepsia
Epigastric pain
Anorexia
N&V
Investigations for gastritis
Helicobacter pylori infection - Urea breath test
Biopsy
Stool antigen test - H pylori
Endoscopy
Autoimmune antibodies
Differential diagnoses for gastritis
Peptic ulcer disease (PUD)
GORD
Gastric carcinoma
Management of gastritis
H pylori eradication - triple therapy PPI and 2 antibiotics twice a day for 7 days
Stop nsaids
No alcohol
First line management of gastritis if H pylori positive
PPI+ Amoxicillin. 1g + clarithromycin 500mg
Complications of gastritis
Peptic ulcers
Bleeding and anaemia
MALT lymphoma
Gastric cancer
Vitamin B12 deficiency
What happens once you lose mucin
Excess acid can enter the stomach lining this can cause an ulcer
How would you reverse the mucosal ischamaie
Treat with colloids
how would you reduce acid in stomach
hydrogen blocker
proton pump inhibitor
What is GORD
Reflux of gastric contents into the oesophagus due to lower oesophageal sphincter relaxation
Risk factors for GORD
Obesity
Pregnancy
Hiatus Hernias
NSAID’S
Alcohol
Physiology of GORD
O propels food into stomach via perilstalsis > at gastro-o junction LOS relaxes so food can enter stomach > after entry contracts to prevent reflux of stomach contents
If LOS relaxes or becomes loose due to drop in pressure stomach content will wash back into oesophagus
pathophysiology in GORD
- LOS pressure gets lower - reflux for longer - pathological
- Persistent acid reflux damages the oesophageal mucosa, causing local inflammation > oedema + erosion of mucosa
- As the epithelium is damaged, it is replaced by scar, making the walls thicker and the lumen narrower
Signs and symptoms of GORD
- Heartburn - retrosternal burning chest pain
- Regurgitation
- epigastric pain
- dysphagia
Why is GORD worse when lying down
easier for acid to regurgitate
In what patients with suspected gord would you use an urgent 2 week referral
Dysphagia or over 55 with weight loss and one of the following
- Upper abdo pain
- Reflux
- Dyspepsia
what may endoscopy show for GORD
- Oesophagitis
- Barrets oesophagus
Clinical investigations for GORD
-FBC
-24HR pH monitoring
- Upper GI Endoscopy
Conservative management of GORD
- SMOKING CESSATION
- reduce alcohol
- lose weight
- eat smaller meals
Medical management of GORD
- GAVISCON
- PPI or H2 receptor antagonists id CI
Lifestyle changes - eat better dktn smoke dietery modifications
What is a common complication of GORD
- metaplasia of stratified squamous to simple columnar epithelium
Complications of GORD
- Typical reflux syndrome
- Reflux chest-pain syndrome
- Barrett’s oesophagus(premalignant condition in the oesophagus due to columnar metaplasia)
- Reflux cough syndrome
- Reflux laryngitis syndrome: reflux goes all the way up to throat and down the larynx
- Reflux asthma syndrom
Last resort management of GORD
Surgical tightening of LOS
What is barrets oesophagus
metaplasia of stratified squamous non keratinising epithelia to simple columnar
causes the oesophagus to be red and inflamed
what does barrets oesophagus increase the likelihood of?
adenocarcinoma
