Gastritis
Gastritis is inflammation, erosion, or damage of the gastric lining that has not developed into
an ulcer.
Chronic gastritis is classified into two:
• Type A (chronic fundal gastritis)
gastritis is caused by atrophy of the gastric mucosa and associated with an
autoimmune process such as vitamin B12 deficiency. It is also associated with diminished
gastric acid production and achlorhydria.
–– All patients with achlorhydria will have markedly elevated gastrin because acid
inhibits gastrin release from G cells.
–– Mucosal-associated lymphoid tissue (MALT) leads to metaplasia as well as possible
dysplasia and then to gastric cancer.
• Type B (chronic antral gastritis) gastritis (most common) can be caused by alcohol,
NSAIDs, Helicobacter, head trauma, burns, and mechanical ventilation. It is also associated
with increased gastric acid production. It commonly involves the antrum and mostly associated
with H. pylori infection. owever, the inflammation may progress to involve the gastric fundus
and body causing pangastritis usually after 15 – 20 years.
Histology improves with eradication of H. pylori.
Clinical Presentation.
• non-erosive gastritis is asymptomatic (except in certain rare causes like Crohn’s disease),
does not cause pain; difficult to diagnose clinically or endoscopically – requires biopsy for
diagnosis
• erosive gastritis can cause bleeding (pain only if progresses to ulcers – rare); can be see
endoscopically
When the gastritis is severe and erosive, abdominal pain will occur in the same area that
patients with
ulcer disease feel theirs. Nausea and vomiting may also occur. The bleeding can present as
hematemesis or melena.
Diagnosis The history of onset of symptoms is important. When symptoms
are acute and the gastritis is associated with infection,
symptoms usually subside within days, and evaluation is unnecessary.
The use of NSAIDs must be evaluated. However, when
symptoms persist longer than 7 to 14 days, an investigation is
necessary. The standard evaluation includes upper GI endoscopy
with biopsy to determine the disease process.
When atrophy is present, a test for parietal cell antibodies is
indicated. Serum gastrin levels may be elevated if atrophy is
diffuse. Evaluation for vitamin B12 is necessary.
The most common cause of gastritis is H. pylori (see Chapter
54). Finding the organism through endoscopy and biopsy confi
rms the diagnosis. When present, other organisms can be
identifi ed on biopsy, but careful histologic staining must be
done to identify chronic infections, such as tuberculosis and
fungi. Anisakiasis can be diagnosed on endoscopy; with the
increased ingestion of raw fi sh, Anisakis infection should be
considered in patients with an appropriate history. Other parasites
also may be identifi ed in the stomach.
Treatment.
When an infectious agent is identifi ed, such as H. pylori or any
parasite, treatment for that infectious agent cures the gastritis.
Autoimmune diseases and nonspecifi c gastric diseases are treated
symptomatically.
When another disease involving the gastric mucosa is identifi
ed, such as Crohn disease or sarcoid, it must be treated. Erosive
gastritis is treated by removing its cause, whether alcohol, drugs,
or other agents.
During the healing phase of gastritis therapy, acidic and
spice-containing foods could further irritate the mucosa and
must be removed from the patient’s diet. Neutralizing acid is
also recommended because the mucosa has many breaks in its
barrier and can be invaded by acid. Therefore, it is advisable
to use acid suppression therapy (H2 inhibitors, proton pump
inhibitors [PPIs], antacids) as tolerated.
The course of gastritis depends on the cause. It can be chronic, troublesome, and difficult to
treat. Most acute forms resolve rapidly. An association with NSAID use must be considered and
may be treated by changing the NSAID or adding a PPI to alleviate symptoms if the NSAID is
essential therapy. Chronic forms are related to the natural history of an associated disease and
must be treated by diet restrictions and antacid therapy. A true atrophic gastritis may be
associated with vitamin B12 def ciency, which should be evaluated.
