Gastritis - upper GI Flashcards
What is gastritis?
histological presence of gastric mucosal inflammation.
The broader term gastropathy encompasses lesions characterised by minimal or no inflammation
What is the aetiology of gastritis?
-
Helicobacter pylori infection may cause both an acute and chronic gastritis.
- Acute non-erosive gastritis is most commonly due to H Pylori
- Chronic H pylori infection predisposes to atrophic gastritis and autoimmune gastritis.
- Erosive gastritis may occur in response to NSAID/alcohol use or misuse and to bile reflux into the stomach that may follow previous gastric surgery or cholecystectomy
- Stress gastritis, most commonly related to mucosal ischaemia seen in critically ill patients, represents a continuum of disease ranging from superficial (erosions) to deep mucosal damage known as stress ulceration.
- Autoimmune gastritis is a diffuse form of mucosal atrophy characterised by auto-antibodies to parietal cells and intrinsic factor resulting in inflammatory infiltration and atrophy of the corpus mucosa.
- Phlegmonous gastritis is a rare but life-threatening infection of the gastric submucosa and muscularis propria seen in immunocompromised patients
How is gastritis classified?
Based on aetiology
.Name the risk factors for gastritis?
- Helicobacter pylori infection
- NSAID use
- alcohol use/toxic ingestions
- prior gastric surgery
- critically ill patients
- autoimmune disease
weak
- immunocompromised
- N European
Summarise the epidemiology of gastritis
Data for the incidence and prevalence of gastritis are not available.
- Dyspeptic symptoms are reported in 10% to 20% of patients taking NSAIDs, although the prevalence may range from 5% to 50%.
- non-ulcer dyspepsia (including gastritis) contributes to the diagnosis in about 50% of patients referred for upper endoscopy
What are the presenting symptoms of gastritis?
-
dyspepsia/epigastric discomfort
- non-specific symptom
-
no red flag symptoms for malignancy
- very low risk for <70yrs
- nausea
- vomiting
- loss of appetite
uncommon
-
severe emesis
- phlegmonous gastritis
- acute abdominal pain
- fever
What are the red flag symptoms for GI malignancy?
- gastrointestinal (GI) bleeding
- anaemia
- early satiety
- unexplained weight loss (>10% body weight)
- progressive dysphagia
- odynophagia
- \persistent vomiting
What are the signs of gastritis O/E?
uncommon
-
altered reflexes or sensory deficits
- Patients may have signs and symptoms consistent with clinical vitamin B₁₂ deficiency
- pernicious anaemia due to chronic gastric inflammation and mucosal atrophy in older people, or autoimmune atrophic gastritis
-
cognitive impairment
- see above
-
glossitis
- see above
- or the ‘fiery red tongue’ associated with pernicious anaemia
-
co-existing autoimmune disease
- autoimmune gastritis may have manifestations of associated autoimmune disease (e.g., thyroid disease, idiopathic adrenocortical insufficiency, vitiligo, type 1 diabetes mellitus, and hypoparathyroidism
Name the primary investigations for ?gastritis?
-
Helicobacter pylori urea breath test
- can also be used to monitor response to therapy.
-
H pylori faecal antigen test
- can also be used to monitor response to therapy.
- bloods: FBC
- variable
- may show reduced Hb and HCT + increased <cv>
</cv><li>leukocytosis with left shift in phlegmonous gastritis</li>
Which factors can interfere with the H Pylori breath test?
- Proton-pump inhibitors (PPIs)
- bismuth
- antibiotics
It is generally recommended that, in the post-treatment setting, PPIs are withheld for 7-14 days and antibiotics and bismuth withheld for at least 28 days prior to use of the urea breath test to assess H pylori eradication
What are some secondary investigations for gastritis?
endoscopy
- Consider in patients with symptoms that are refractory to treatment
- Patients with confirmed pernicious anaemia should undergo endoscopy to evaluate for any associated gastric malignancy
H pylori rapid urease test
- Performed on biopsy tissue obtained during endoscopy
- not regularly relied on as there are the breath + stool tests
gastric mucosal histology
- Provides histological diagnosis and classification of gastritis
bloods: B12
- low or normal in autoimmune gastritis
upper GI contrast series
- less useful for diagnosis of gastritis.
- confirmation of phlegmonous gastritis may be obtained from a plain upper GI contrast series and/or CT
blood/fluid cultures
- Recommended if phlegmonous gastritis is suspected
- Cultures of blood and gastric aspirates are performed
parietal cell antibodies
- Present in about 90% of patients with atrophic gastritis
- positive in autoimmune gastritis
intrinsic factor antibodies
- Highly sensitive for pernicious anaemia
- positive in autoimmune gastritis
Explain the management plan for gastritis
What is an emerging test for ?gastritis
H pylori culture/PCR
- Performed on biopsy tissue obtained during endoscopy
- High sensitivity and specificity for H pylori infection
- although less sensitive than rapid urease testing
- less routinely available
Name some possible complications of gastritis
+ vitamin B12 defiency
+ peptic ulcer diease
Summarise the prognosis of gastritis
