Diagnosis

Gastritis

Etiology

Cause [9zh]

• Infection:

  • Bacteria: H.pylori, H heilmannii, tuberculosis, syphilis

  • Viral: CMV, herpes simplex virus

  • Parasitic gastritis (Anisakis, Cryptosporidium, Ascaris lumbricoides, Giardia, Toxoplasma, and Schistosoma)

  • Fungal gastritis (Candida, Aspergillus, Mucor, Coccidioides, Histoplasma, Cryptococcus neoformans, Pneumocystis carinii, and Torulopsis glabrata)

• Autoimmune gastritis

• Gastritis due to other diseases

  • Crohn disease

  • Sarcoidosis

  • Vasculitis

• Gastritis due to external causes

  • Alcoholism

  • NSAIDs

  • Nicotine

  • Alcohol

  • Radiation/Chemotherapy

  • Chemicals

• Special gastritis

  • Allergic (eosinophilic) gastritis

  • Gastritis due to biliary reflux

  • Lymphocytic gastritis

  • Ménétrier disease

  • Eosinophilic gastritis

• Other:

  • Ischemia

  • Iron-induced gastritis

  • Glucocortocoids

  • Chemotherapy

  • Radiation

• Acute gastritis:

  • Uremia, ischemia, shock, corrosive agents, medications, radiation, trauma, severe burns, sepsis, or alkaline-bile reflux

• Chronic gastritis:

  1. Atrophic: autoimmune gastritis

  2. Non-atrophic (may progress to atrophic): Helicobacter pylori

• Reactive gastritis or gastropathy:

  • Medications, alcohol, radiation exposure, and duodenal (bile) reflux

Pathophysiology [9zh]

1. H pylori --> bacterial virulence factors (cell adhesion, cell damage, disrupt tight junctions, and evade the host immune response)

2. Disrupts the gastric mucosal barrier --> chronic inflammation

3. Autoimmune gastritis: T-cell–mediated destruction of the mucosa and the production of autoantibodies targeting parietal cells and the intrinsic factor

   • Associated with pernicious anemia

4. Gastritis may progress to premalignant atrophy --> dysplasia --> gastric cancer

Complications [9zh]

• Peptic ulcer disease

• Immune thrombocytopenic purpura

• Iron-deficiency anemia (autoimmune and H pylori–induced gastritis)

• Vitamin B12 deficiency

• Atrophic gastritis

• Gastric cancer (complication of atrophic gastritis)

• Gastric neuroendocrine tumor (complication of atrophic gastritis)

• Gastric lymphoma (associated with H pylori–induced gastritis)

Epidemiology

Incidence per 100.000 [kaf][wm1]

Approach

• Blood test: Liver, gallbladder, kidney and pancreatic function tests

• Pregnancy test

• H pylori: stool antigen test, Urea breath test, Serum antibodies test

• Stool for blood

• ECG

• Gastroscopy: Rapid urease test, Bacterial culture, 5 separate biopsies

Diagnostic criteria [9zh]

• Evidence of atrophic gastritis (gastroscopy)

• Autoantibodies against the intrinsic factor and parietal cells

• Serum pepsinogen I levels

• The ratio of pepsinogen I to pepsinogen II

Treatment

1. Medical treatment: Treatment of the underlying cause

   • Avoid NSAIDs, caffeine, smoking

   • H Pylori eradication: 

     • Bismuth + nitroimidazole + tetracycline + PPI for 10-14 days or 

     • Clarithromycin + amoxicillin/amitronidazole + PPI for 14 days or 

     • Clarithromycin + amoxicillin + nitroimidazole for 14 days

2. Surgery:

   • Phlegmonous gastritis or acute necrotizing gastritis

Differential diagnoses

Celiac disease, Cholecystitis, Cholelithiasis, Chronic pancreatitis, Crohn disease, Eosinophilic esophagitis, Eosinophilic gastroenteritis, Gastric cancer, Gastric lymphoma, Gastroenteritis, Gastroesophageal reflux disease, Myocardial infarction, Pernicious anemia, Ulcer disease, Zollinger-Ellison syndrome