The Stomach

What is Gastritis?

 An inflammation, irritation or erosion

of the stomach lining. Can be of
acute or a chronic complaint.
 Acute gastritis often due to chemical
injury (alcohol/drugs)
 Chronic gastritis: H. Pylori infection,
chemical, autoimmune.
What Causes Gastritis?
 Bile reflux Drugs
 NSAIDs, such as aspirin, ibuprofen, and naproxen
 Cocaine
 Iron
 Colchicine, when at toxic levels, as in patients with
failing renal or hepatic function
 Kayexalate
 Chemotherapeutic agents, such as mitomycin C, 5-
fluoro-2-deoxyuridine, and floxuridine
 Potent alcoholic beverages, such as whisky, vodka,
and gin
 Bacterial infections
 H pylori (most frequent)
 H heilmanii (rare)
 Streptococci (rare)
 Viral infections (eg, CMV)
 Fungal infections
 Candidiasis
 Histoplasmosis
 Phycomycosis
 Parasitic infection (eg, anisakidosis)
 Acute stress (shock)
 Radiation
 Allergy and food poisoning
 Spicy food
 Smoking
 Bile: The reflux of bile (an alkaline medium
important for the activation of digestive enzymes
in the small intestine) from the small intestine to
the stomach can induce gastritis.
 Ischemia: This term is used to refer to damage
induced by decreased blood supply to the
stomach. This rare etiology is due to the rich blood
supply to the stomach.
 Direct trauma
 Acute
 Acute gastritis is a term covering a
broad spectrum of entities that induce
inflammatory changes in the gastric
mucosa.
 The different etiologies share the same
general clinical presentation. However,
they differ in their unique histologic
characteristics.
 The inflammation may involve the
entire stomach (eg, pangastritis) or a
region of the stomach (eg, antral
gastritis).
 Acute gastritis can be broken down
into 2 categories: erosive (eg,
superficial erosions, deep erosions,
hemorrhagic erosions) and nonerosive
Erosive Gastritis
 Acute erosive gastritis can result from the
exposure to a variety of agents or factors.
This is referred to as reactive gastritis.
 These agents/factors include nonsteroidal
anti-inflammatory medications (NSAIDs),
alcohol, cocaine, stress, radiation, bile
reflux, and ischemia.
 The gastric mucosa exhibits hemorrhages,
erosions, and ulcers. NSAIDs, such as
aspirin, ibuprofen, and naproxen, are the
most common agents associated with
acute erosive gastritis.
 This results from oral or systemic
administration of these agents either in
therapeutic doses or in supratherapeutic
Chronic

The ABC in chronic Gastritis:

 A – Autoimmune
 B – Bacterial (H. Pylori)
 C – Chemical (NSAIDs)
 Chronic noninfectious granulomatous
gastritis
 Lymphocytic gastritis
 Eosinophilic gastritis
 Ischemic gastritis
 Radiation gastritis
 Autoimmune Gastritis
 This type of gastritis is associated with
serum antiparietal and anti-intrinsic
factor (IF) antibodies.
 The gastric corpus undergoes
progressive atrophy, IF deficiency
occurs, and patients may develop
pernicious anemia.
 Autoantibodies are directed against at
least 3 antigens, including IF,
cytoplasmic (microsomal-canalicular),
and plasma membrane antigens.
 Two types of IF antibodies are detected,
ie, types I and II. Type I IF antibodies
block the IF-cobalamin binding site, thus
preventing the uptake of vitamin B-12.
Cell-mediated immunity also contributes
to the disease.
 T-cell lymphocytes infiltrate the gastric
mucosa and contribute to epithelial cell
destruction and resulting gastric
 H. pylori
 The corkscrew-shaped bacterium
called H pylori is the most common
cause of gastritis.
 Complications result from a
chronic infection rather than from
an acute infection.
 The prevalence of H pylori in
otherwise healthy individuals
varies depending on age,
socioeconomic class, and country
of origin.
 In the Western world, the number
of people infected with H pylori
increases with age.  H pylori gastritis typically starts as an
acute gastritis in the antrum, causing
 Evidence of H pylori infection can
intense inflammation, and over time, it
be found in 20% of individuals may extend to involve the entire gastric
younger than 40 years and in 50% mucosa resulting in chronic gastritis.
of individuals older than 60 years.
 Tuberculosis is a rare cause of gastritis, but an increasing number of
cases have developed because of patients who are
immunocompromised. Gastritis caused by tuberculosis is generally
associated with pulmonary or disseminated disease.
 Secondary syphilis of the stomach is a rare cause of gastritis.
 Phlegmonous gastritis is an uncommon form of gastritis caused by
numerous bacterial agents, including streptococci, staphylococci,
Proteus species, Clostridium species, and Escherichia coli.
 Viral infections can cause gastritis. Cytomegalovirus (CMV) is a
common viral cause of gastritis. It is usually encountered in individuals
who are immunocompromised, including those with cancer,
immunosuppression, transplants, and AIDS. Gastric involvement can be
localized or diffuse.
 Fungal infections that cause gastritis include Candida albicans and
histoplasmosis. The common predisposing factor is
immunosuppression. C albicans rarely involves the gastric mucosa.
 Parasitic infections are rare causes of gastritis. Anisakidosis is caused
by a nematode that embeds itself in the gastric mucosa along the
greater curvature. Anisakidosis is acquired by eating contaminated
sushi and other types of contaminated raw fish. It often causes severe
abdominal pain that subsides within a few days. This nematode
infection is associated with gastric fold swelling, erosions, and ulcers.
 Ulcero-hemorrhagic gastritis is most commonly seen in patients who
are critically ill. Ulcero-hemorrhagic gastritis is believed to be
secondary to ischemia related to hypotension and shock or to the
release of vasoconstrictive substances, but the etiology is often
unknown.
 Microscopic evidence of acute gastritis can be seen in patients with
Chemical Gastritis
 This type of gastritis is associated with long-term intake of
aspirin or NSAIDs.
 It also develops when bile-containing intestinal contents
reflux into the stomach.
 Although bile reflux may occur in the intact stomach, most
of the features associated with bile reflux are typically
found in patients with partial gastrectomy, in whom the
lesions develop near the surgical stoma.
 The mechanisms through which bile alters the gastric
epithelium involve the effect of several bile constituents.
Both lysolecithin and bile acids can disrupt the gastric
mucous barrier, allowing the back diffusion of positive
hydrogen ions and resulting in cellular injury.
 Pancreatic juice enhances epithelial injury in addition to
bile acids. In contrast to other chronic gastropathies,
minimal inflammation of the gastric mucosa typically
occurs in chemical gastropathy.
Chronic noninfectious
granulomatous gastritis
 Noninfectious diseases are the usual
cause of gastric granulomas and
include Crohn disease, sarcoidosis, and
isolated granulomatous gastritis.
 Crohn disease demonstrates gastric
involvement in approximately 33% of
the cases. Granulomas have also been
described in association with gastric
malignancies, including carcinoma and
malignant lymphoma.
 Sarcoidlike granulomas may be
observed in people who use cocaine,
and foreign material is occasionally
observed in the granuloma.
Lymphocytic/
Eosinophilic Gastritis
 Lymphocytic gastritis
 This is a type of chronic gastritis with dense
infiltration of the surface and foveolar
epithelium by T lymphocytes and associated
chronic infiltrates in the lamina propria.
 Eosinophilic gastritis
 Large numbers of eosinophils may be observed
with parasitic infections such as those caused by
Eustoma rotundatum and anisakiasis.
 Eosinophilic gastritis can be part of the
spectrum of eosinophilic gastroenteritis.
Although the gastric antrum is commonly
affected, this condition can affect any segment
of the GI tract and can be segmental. Patients
frequently have peripheral blood eosinophilia..
Radiation/ Ischemic
Gastritis
 Radiation gastritis
 Small doses of radiation (up to 1500 R) cause
reversible mucosal damage, whereas higher
radiation doses cause irreversible damage with
atrophy and ischemic-related ulceration. Reversible
changes consist of degenerative changes in
epithelial cells and nonspecific chronic inflammatory
infiltrate in the lamina propria.
 Higher amounts of radiation cause permanent
mucosal damage, with atrophy of fundic glands,
mucosal erosions, and capillary hemorrhage.
Associated submucosal endarteritis results in
mucosal ischemia and secondary ulcer development.
 Ischemic gastritis
 Ischemic gastritis is believed to result from
atherosclerotic thrombi arising from the celiac and
superior mesenteric arteries.
What are the symptoms?
Vomiting

Thirst

Nausea
Bloating

Indigestion

Pain in
Epigastric
Region
...symptoms

 Gastrointestinal bleeding
 Hemoptysis
 Melena
 Diarrhea
 Chest Pain (associated with
indigestion)
 Unpleasant taste in mouth
 Apetite
 How do we diagnose?
 A doctor suspects gastritis when a
person has upper abdominal discomfort
or pain or nausea.
 Blood tests
 Liver, Kidney, Gallbladder and Pancreas
functions
 Urinalysis/stool sample
 X-ray/ECG
 Nasogastric Intubation
 ENDOSCOPY
 Capsule Endoscopy
 Laparoscopy
Endoscopy

Endoscopy is an examination of internal structures using a flexible

viewing tube (endoscope).
 Endoscope is passed through the
mouth, to the stomach, examining
the lining of the stomach
 Many endoscopes are equipped with
a small clipper with which tissue
samples can be taken (endoscopic
biopsy)
 Endoscopes can also be used for
treatment.
 Capsule Endoscopy
 Capsule endoscopy is a
procedure in which the person
swallows a battery-powered
capsule.
 The capsule contains one or two
small cameras, a light, and a
transmitter.
 Images of the lining of the
intestines are transmitted to a
receiver worn on the person's
belt or in a cloth pouch.
 Thousands of pictures are taken.
 This technology is especially
good at finding problems on the
inner surface of the small
intestine, which is an area that
is difficult to evaluate with an
endoscope.
Nasogastric Tube
 Intubation of the
digestive tract is the
process of passing a
small, flexible plastic
tube (nasogastric
tube) through the
nose or mouth into the
stomach or small
intestine.
 This procedure may
be used for diagnostic
or treatment
purposes.
 Nasogastric intubation
can be used to obtain The tube is passed through the nose rather
a sample of stomach
fluid. than through the mouth, primarily because
 This determines the tube can be more easily guided to the
whether the stomach oesophagus.
contains blood, or Also, passage of a tube through the nose is
they can analyze the less irritating and less likely to trigger
stomach's secretions coughing.