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Gastritis

Micha Holecki, MD, PhD


Department of Pathophysiology

Gastritis includes a myriad of disorders that involve inflammatory changes in the gastric mucosa, including:
1. erosive gastritis caused by a noxious irritant

2. reflux gastritis from exposure to bile and pancreatic fluids


3. hemorrhagic gastritis

4. infectious gastritis
5. gastric mucosal atrophy

Acute gastritis

an acute mucosal inflammatory process, usually of a transient nature severe erosive form is an important cause of acute gastrointestinal bleeding

Pathophysiology
The mechanisms of mucosal injury in gastritis and PUD are thought to be an imbalance of aggressive factors

acid production or pepsin


and defensive factors mucus production bicarbonate and blood flow

Pathophysiology

Erosive gastritis usually is associated with serious illness or with various drugs. Stress, ethanol, bile, and nonsteroidal antiinflammatory drugs (NSAIDs) disrupt the gastric mucosal barrier, making it vulnerable to normal gastric secretions.

Pathophysiology

NSAIDs and aspirin also interfere with the protective mucus layer by inhibiting mucosal cyclooxygenase activity, reducing levels of mucosal prostaglandins

Sex:
Male-to-female ratio

of gastritis is

approximately 1:1

Male-to-female ratio of PUD is approximately 2:1

Age:

An estimated 60% of Americans older than 60 years harbor H pylori. Duodenal ulcers usually occur in those aged 2575 years. Gastric ulcer incidence peaks in those aged 55-65 years.

Acute gastritis

Acute gastritis
Acute hemorrhagic gastritis Acute erosive gastritis Acute stress gastritis

Patients typically present with abdominal pain


that has the following characteristics

Epigastric to left upper quadrant


Frequently described as burning

May radiate to the back


Usually occurs 1-5 hours after meals

May be relieved by food, antacids (duodenal), or vomiting (gastric)


Typically follows a daily pattern specific to patient

Physical

Epigastric tenderness is present and usually mild.

Bowel sounds are normal.


Signs of peritonitis or GI bleeding may manifest. (Perform a rectal examination and Hemoccult testing)

Causes

H pylori (most common cause of ulceration) NSAIDs, aspirin Gastrinoma (Zollinger-Ellison syndrome) Severe stress (eg, trauma, burns), Curling ulcers Alcohol Bile reflux Pancreatic enzyme reflux Radiation Staphylococcus aureus exotoxin Bacterial or viral infection

Differential diagnosis
Acute Coronary Syndrome [Aneurysms, Abdominal] Cholangitis Cholecystitis and Biliary Colic Cholelithiasis Diverticular Disease Esophagitis Gastroenteritis Hepatitis Inflammatory Bowel Disease

Differential diagnosis
Mesenteric Ischemia

Myocardial Infarction
Pancreatitis

Pulmonary Embolism
Renal Calculi

Other Problems to be Considered:


Gastric cancer Esophageal varices Mallory-Weiss tears Atrophic gastritis Nonulcer dyspepsia Functional gastrointestinal disorder Atypical appendicitis in the pregnant patient

Complications:

Malignancy

Hemorrhage
Perforation Obstruction

Patients should be warned of known or potentially injurious drugs and agents. Some examples are as follows: o NSAIDs o Aspirin o Alcohol

Caffeine (eg, coffee, tea, colas)

Chronic gastritis

Type A [fundal] gastritis

Type B [antral] gastritis

[a] hypersecretory gastritis [b] environmental gastritis.

Hypertrophic gastritis

Type A [fundal] gastritis


circulating antibodies to parietal cells and intrinsic factor hypo- or achlorhydria a high intragastric pH and hypergastrinemia 10% of patients go on develop overt pernicious anemia associated with autoimmune disorders such as Hashimotos thyroiditis and Adisons disease

Type B [antral] gastritis

the hypersecretory type

- restricted to the antrum - gastric hypersecretion - frequently symptomatic

the environmental gastritis

- the most common form of gastritis in all age groups - irregularly focal involvment of the antral mucosa - gradually extends deeper into the mucosa and cause mucosal atrophy

Hypertrophic gastritis
Three variants are recognized

Menetriers disease Hypersecretory gastropathy

Gastric gland hyperplasia [the Zollinger-Ellison syndrome]

All three types are characterized by giant cerebriform enlargement of the rugal folds of the gastric mucosa

Stress ulcers

Shock
Extensive burns

Sepsis
Trauma Brain tumors and following intracranial surgery

Etiology of stress ulcers


Neurogenic or catecholamine-induced vasoconstriction

Mucosal ischemia

Damage the mucosal barrier

Directly injure mucosal cells by oxygen or metabolic deprivation

Stress ulcers

Those associated with intracranial problems are referred to as Cushings ulcers. Those associated with shock an extensive burns are referred to as Curlings ulcers.