Stomach & Duodenum

Question 1

What is meant by the term “gastropathy”?

Answer 1

there is injury to the gastric mucosa associated with epithelial cell damage and regeneration

there is little or no accompanying inflammation

Question 2

What is meant by the term “gastritis”?

Answer 2

inflammation of the gastric mucosa

Question 3

What is the main cause of gastropathy and why?

Answer 3

the commonest cause of gastropathy is mucosal damage associated with the use of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs deplete mucosal prostaglandins, by inhibiting the cyclo-oxygenase pathway, which leads to mucosal damage

Question 4

What are other causes of gastropathy?

Answer 4

• infections - cytomegalovirus / herpes simplex virus
• alcohol in high concentrations
• severe stress (stress ulcer)
• burns (Curling’s ulcer)
• in renal and liver disease

Question 6

What are the symptoms associated with gastropathy?

Answer 6

• indigestion
• vomiting
• haemorrhage

these correlate poorly with endoscopic and pathological findings

Question 7

What can be seen at endoscopy in someone with gastropathy?

Answer 7

• erosions (superficial breaks in the mucosa < 3mm)
• subepithelial haemorrhage

Question 8

What is the treatment for someone with gastropathy?

Answer 8

• treatment with a proton pump inhibitor (PPI) with removal of the offending cause if possible
• prophylaxis is given to prevent further damage in patients who continue to take aspirin or NSAIDs

Question 9

What is the commonest cause of gastritits?

Answer 9

Helicobacter pylori infection

Question 10

What are other causes of gastritis?

Answer 10

• autoimmune gastritis (the cause of pernicious anaemia associated with antibodies to gastric parietal cells and intrinsic factor)
• viruses
• duodenogastric reflux

Question 11

How is gastritis diagnosed?

Answer 11

gastritis is a histological diagnosis and is usually discovered incidentally when a gastric mucosal biopsy is taken for histology at endoscopy

Question 12

What is the difference between acute and chronic gastritis?

Answer 12

acute:

• acute inflammation is associated with neutrophilic infiltration

chronic:

• chronic inflammation is characterised by mononuclear cells (mainly lymphocytes, plasma cells & macrophages)

Question 13

What are the symptoms of gastritis?

Answer 13

It is usually asymptomatic

whether H. pylori gastritis itself produces functional dyspepsia is controversial

Question 14

What does the mucosa look like in gastritis at endoscopy?

How is it treated?

Answer 14

the mucosa may appear reddened or normal

no specific treatment is required although eradication treatment for H. pylori is often given