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EROSIVE GASTRITIS

Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defenses. It is


typically acute, manifesting with bleeding, but may be subacute or chronic with few or
no symptoms. Diagnosis is by endoscopy. Treatment is supportive, with removal of the
inciting cause. Certain ICU patients (eg, ventilator-bound, head trauma, burn, multisystem
trauma) benefit from prophylaxis with acid suppressants.
Causes of erosive gastritis include NSAIDs, alcohol, stress, and less commonly radiation,
viral infection (eg, cytomegalovirus), vascular injury, and direct trauma (eg, nasogastric
tubes).
Superficial erosions and punctate mucosal lesions occur. These may develop as soon as 12 h
after the initial insult. Deep erosions, ulcers, and sometimes perforation may occur in severe
or untreated cases. Lesions typically occur in the body, but the antrum may also be involved.
Acute stress gastritis, a form of erosive gastritis, occurs in about 5% of critically ill patients.
The incidence increases with duration of ICU stay and length of time the patient is not
receiving enteral feeding. Pathogenesis likely involves hypoperfusion of the GI mucosa,
resulting in impaired mucosal defenses. Patients with head injury or burns may also have
increased secretion of acid.
Symptoms and Signs
Patients with mild erosive gastritis are often asymptomatic, although some complain of
dyspepsia, nausea, or vomiting. Often, the first sign is hematemesis, melena, or blood in the
nasogastric aspirate, usually within 2 to 5 days of the inciting event. Bleeding is usually mild
to moderate, although it can be massive if deep ulceration is present, particularly in acute
stress gastritis. Acute and chronic erosive gastritis are diagnosed endoscopically.
Diagnosis
Acute and chronic erosive gastritis are diagnosed endoscopically.
Treatment
For bleeding: Endoscopic hemostasis
For acid suppression: A proton pump inhibitor or H
2
blocker
In severe gastritis, bleeding is managed with IV fluids and blood transfusion as needed.
Endoscopic hemostasis should be attempted, with surgery (total gastrectomy) a fallback
procedure. Angiography is unlikely to stop severe gastric bleeding because of the many
collateral vessels supplying the stomach. Acid suppression should be started if the patient is
not already receiving it.
For milder gastritis, removing the offending agent and using drugs to reduce gastric acidity
(see Drug Treatment of Gastric Acidity) may be all that is required.
Prevention
Prophylaxis with acid-suppressive drugs can reduce the incidence of acute stress gastritis.
However, it mainly benefits certain high-risk ICU patients, including those with severe burns,
CNS trauma, coagulopathy, sepsis, shock, multiple trauma, mechanical ventilation for > 48 h,
hepatic or renal failure, multiorgan dysfunction, and history of peptic ulcer or GI bleeding.
Prophylaxis consists of IV H
2
blockers, proton pump inhibitors, or oral antacids to raise
intragastric pH> 4.0. Repeated pH measurement and titration of therapy are not required.
Early enteral feeding also can decrease the incidence of bleeding.
Acid suppression is not recommended for patients simply taking NSAIDs unless they have
previously had an ulcer.
NONEROSIVE GASTRITIS
Nonerosive gastritis refers to a variety of histologic abnormalities that are mainly the result
of H. pyloriinfection. Most patients are asymptomatic. Diagnosis is by endoscopy. Treatment
is eradication of H. pylori and sometimes acid suppression.
Pathology
Superficial gastritis:
Lymphocytes and plasma cells mixed with neutrophils are the predominant infiltrating
inflammatory cells. Inflammation is superficial and may involve the antrum, body, or both. It
is usually not accompanied by atrophy or metaplasia. Prevalence increases with age.



Deep gastritis:
Deep gastritis is more likely to be symptomatic (eg, vague dyspepsia). Mononuclear cells and
neutrophils infiltrate the entire mucosa to the level of the muscularis, but exudate or crypt
abscesses seldom result, as might be expected by such infiltration. Distribution may be
patchy. Superficial gastritis may be present, as may partial gland atrophy and metaplasia.



Gastric atrophy:
Atrophy of gastric glands may follow in gastritis, most often long-standing antral (sometimes
referred to as type B) gastritis. Some patients with gastric atrophy have autoantibodies to
parietal cells, usually in association with corpus (type A) gastritis and pernicious anemia.



Atrophy may occur without specific symptoms. Endoscopically, the mucosa may appear
normal until atrophy is advanced, when submucosal vascularity may be visible. As atrophy
becomes complete, secretion of acid and pepsin diminishes and intrinsic factor may be lost,
resulting in vitamin B
12
malabsorption.
Metaplasia:
Two types of metaplasia are common in chronic nonerosive gastritis: mucous gland and
intestinal.



Mucous gland metaplasia (pseudopyloric metaplasia) occurs in the setting of severe atrophy
of the gastric glands, which are progressively replaced by mucous glands (antral mucosa),
especially along the lesser curve. Gastric ulcers may be present (typically at the junction of
antral and corpus mucosa), but whether they are the cause or consequence of these
metaplastic changes is not clear.
Intestinal metaplasia typically begins in the antrum in response to chronic mucosal injury and
may extend to the body. Gastric mucosa cells change to resemble intestinal mucosawith
goblet cells, endocrine (enterochromaffin or enterochromaffin-like) cells, and rudimentary
villiand may even assume functional (absorptive) characteristics. Intestinal metaplasia is
classified histologically as complete (most common) or incomplete. With complete
metaplasia, gastric mucosa is completely transformed into small-bowel mucosa, both
histologically and functionally, with the ability to absorb nutrients and secrete peptides. In
incomplete metaplasia, the epithelium assumes a histologic appearance closer to that of the
large intestine and frequently exhibits dysplasia. Intestinal metaplasia may lead to stomach
cancer.
Symptoms and Signs
Most patients with H. pyloriassociated gastritis are asymptomatic, although some have mild
dyspepsia or other vague symptoms. Often the condition is discovered during endoscopy
performed for other purposes. Testing of asymptomatic patients is not indicated. Once
gastritis is identified, testing for H. pylori is appropriate.
Diagnosis
Endoscopy
Often, the condition is discovered during endoscopy done for other purposes. Testing of
asymptomatic patients is not indicated. Once gastritis is identified, testing for H. pylori is
appropriate.
Treatment
Eradication of H. pylori
Sometimes acid-suppressive drugs
Treatment of chronic nonerosive gastritis is H. pylori eradication (see Treatment). Treatment
of asymptomatic patients is somewhat controversial given the high prevalence of H. pylori
associatedsuperficial gastritis and the relatively low incidence of clinical sequelae (ie, peptic
ulcer disease). However, H. pylori is a class J carcinogen; eradication removes the cancer
risk. In H. pylorinegative patients, treatment is directed at symptoms using acid-suppressive
drugs (eg, H
2
blockers, proton pump inhibitors) or antacids



http://www.merckmanuals.com/professional/gastrointestinal_disorders/gastritis_and_peptic_
ulcer_disease/gastritis.html
ast full review/revision January 2007 by Sidney Cohen, MD
Content last modified November 2013

















Erosive Gastritis


There are a lot of different gastro-intestinal disorders that can affect your body. Erosive
gastritis is one such disorder that can cause a lot of pain and a slow degeneration of the gastro
intestinal tract. Regular use of pain killers and steroids can slowly erode the lining of
the stomach and intestines, resulting in the formation of small ulcers. You will eventually
start to feel extremely uncomfortable every time you eat anything.
Gastritis is a condition in which the lining of the gastrointestinal organs becomes inflamed.
However, in erosive gastritis the lining slowly wears away, revealing holes in the flesh of the
organ.
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This is a chronic condition that develops slowly through the years. Due to its chronic nature,
it is also known as chronic erosive gastritis. This is one of the main differences between
nonerosive gastritis and the erosive variety. Acute erosive gastritis may occur due to acute E.
coli infections or consumption of a large amount of steroids over a short period of time.
Severe erosive gastritis may require immediate medical attention. However, it cannot be
completely treated. With drugs and diet, the condition can be effectively managed, but there
are brief periods when the gastritis may simply flare up and cause a lot of discomfort. Mild
erosive gastritis, though not reversible can be managed to a large extent. The flare ups are
brief, and the pain and discomfort is not too much.
A gastritis diet usually excludes all kinds of foods that could cause bloating, discomfort and
flatulence. Such a diet also excludes most spices and almost all kinds of fats. Depending on
the severity of the condition, your doctor will advise you and starting a diet to manage your
gastritis. Erosive gastritis diet may also be set up using the advice of a dietician. Erosive
gastritis symptoms are very simple to identify. These symptoms are very much like those of
gastritis in general and only a detailed medical checkup would help a doctor diagnose the
exact condition. Since erosive gastritis causes are also similar to the causes of general
gastritis, it makes the erosive gastritis diagnosis even more difficult. Erosive gastritis
treatment usually includes medication and a diet. In severe cases, surgery may have to be
performed to remove the diseased tissue. This surgery is performed to prevent an infection
from spreading.
Erosive Gastritis Symptoms, Causes, Treatment & Diagnosis


Symptoms
Most of the erosive gastritis symptoms are very easy to identify, but they are also extremely
unpleasant and uncomfortable. Some of the most common symptoms of this condition
include:
Bloating, flatulence, increased belching, indigestion, and a change in stools.
You may experience pain once you consume food or even water.
The patient may also experience a sudden loss of appetite and an eventual loss in weight.
The weight loss is usually drastic, in which the patient may lose drastic amounts of weight
in a very short period.
If you experience acute erosive gastritis due to stress, you would experience nausea and
vomiting.
In a rare case, erosive gastritis may lead to bleeding in the stomach. The blood may appear
in the stools, and some patients may even experience bloody vomits. Blood is rare in
erosive gastritis, and those who experience this symptom may also experience other
gastritis symptoms for at least a week before the bleeding begins. It is recommended that
those who have persistent symptoms for more than a week should discuss their condition
with a doctor as soon as possible.
Causes
There are a number of factors that cause erosive gastritis
One of the main erosive gastritis causes are a damaged stomach lining. This could occur
due to underlying medical conditions such as Crohn's disease, food allergies and
intolerances, colic, persistent acidity, gastrointestinal reflux, and infections due to bacteria
like E. coli.
While all of these can cause erosive gastritis, the condition is more commonly caused due
to excessive consumption of certain drugs such as steroids and non-steroidal anti-
inflammatory drugs or NSAIDs.
Genetic conditions, viral diseases and bacterial diseases may also cause damage to the
stomach lining. Long-term use of over the counter medications, without consultation with a
doctor can also cause this condition.
Stress is often also associated with erosive gastritis. Though there is not much evidence to
support this theory, many doctors feel that managing stress and improving overall quality
of life may help you prevent erosive gastritis. Trauma to the stomach, which causes injury
to the lining of the gastrointestinal organs, may decrease the blood circulation to the organs,
and ultimately lead to a lack of nutrition to the tissues.
Treatment
Erosive gastritis treatment is usually based on the diagnosis given by the doctor. Most
treatments are a combination of diet and medication. There are some small dietary and
lifestyle changes that you can practice in order to manage your condition. Erosive gastritis
remedies can also be used to prevent the condition from getting worse.
Start off by evaluating your meals. Eat small meals throughout the day, but make sure you
do not eat junk foods as that will just aggravate the condition. Consume foods that are easy
to digest. Avoid consuming fibers, fats and spices in your food. Avoid consuming whole
grains, cereals, non-citrus fruits, green vegetables and dairy products. You may also have to
avoid acidic foods such as tomatoes, oranges, and pineapple.
Avoid consuming caffeine and alcohol. Stub the butt if you are a smoker. Even second-
hand smoking can aggravate the condition, so it is important to avoid second-hand smoke
as well.
Processed foods that have added flavorings, preservatives, and added colors can cause
problems. In addition to this, avoid consuming processed meats like sausages, salami, and
pepperoni. Try and avoid drinking fizzy drinks as those could irritate your stomach's lining.
Stress-relieving exercises such as deep breathing and meditation can help you keep
your stress levels low. In this manner, you can prevent acute gastritis or stress induced flare
ups.
There is no erosive gastritis cure, but with the right kind of lifestyle and food habits, you can
attempt erosive gastritis prevention. However, before using any home remedies, it is
important to consult the doctor.
Diagnosis
The process of erosive gastritis diagnosis begins with the evaluation of symptoms. The doctor
will discuss the symptoms of the patient in detail. A physical exam is conducted, in which the
doctor attempts to locate exactly where the patient feels pain in the abdomen. Since the
symptoms of erosive gastritis are similar to those of general gastritis, the doctor may have to
take some additional tests to confirm the diagnosis. A blood sample may be taken to confirm
the presence of viruses or bacteria. The doctor may also take a stool sample to check for
blood. Some doctors also perform a small biopsy of the stomach to look for degeneration of
the stomach lining. This is usually done through an endoscopy performed at the doctor's
office. Further testing may include an ultrasound to check the stomach lining and an X-ray of
the stomach. Once the condition is diagnosed, the doctor will discuss a treatment plan in
detail. The doctor may put you on a diet and may also prescribe a proton pump inhibitor. A
course of antibiotics may be prescribed in case of bacterial infections. Erosive gastritis
prognosis is a debilitating condition and treatment for the same usually lasts long.