Stomach: Gastritis

Gastritis

Basics

  • Definition: Inflammation Associated with Gastric Mucosal Injury
  • Multiple Classification Systems Controversial
  • Inflammatory Changes
    • Acute – Neutrophilic
    • Chronic – Mixture of Mononuclear Cells (Macrophages, Lymphocytes & Plasma Cells)

Chronic Gastritis

  • Type A
    • Cause: Autoimmune – Antibodies to Parietal Cells & Intrinsic Factor
    • Site: Fundus
    • Causes Pernicious Anemia, Achlorhydria & Gastric Atrophy
  • Type B
    • Cause: H. pylori Bacteria
    • Site: Antrum Predominantly
  • Type C
    • Cause: Chemical Gastritis from NSAIDs, Alcohol or Reflux of Duodenal Contents
      • NSAIDs Inhibit Cyclooxygenase Reducing Mucosal Prostaglandin Synthesis – Causes Reduced Blood Flow & Reduced Bicarbonate/Mucin Secretion
    • Site: Antrum & Body

Stress Gastritis

  • Inflammation that Occurs 3-10 Days After a Stress While in the Hospital/ICU
  • First Seen in Fundus
  • Greatest Risk Factors: Coagulopathy & Prolonged Ventilation
  • Stress Ulcer Prophylaxis (SUP) Indications:
    • Major Criteria:
      • Coagulopathy
      • Mechanical Ventilation > 48 Hours
      • History of GI Ulcer/Bleed Within the Last Year
      • TBI, Traumatic Spinal Cord Injury or Burn Injury
    • Minor Criteria (≥ 2):
      • Sepsis
      • ICU Stay > 1 Week
      • Occult GI Bleeding for ≥ 6 Days
      • Steroid Therapy

Diagnosis

  • Dx: EGD & Bx

Treatment

  • Tx: PPI (Omeprazole or Pantoprazole/Protonix)
    • PPIs are Better Than H2 Blockers (Famotidine/Pepcid)
  • H. pylori Tx: Mn
    • Triple Therapy
      • Clarithromycin
      • Amoxicillin/Metronidazole
      • PPI
    • Quadruple Therapy
      • Bismuth
      • Metronidazole
      • Tetracycline
      • PPI
    • Test for Eradication 4 Weeks After Completion of Therapy
      • Best Test: Urea Breath Test
      • Must Hold PPI 2 Weeks Prior to Test

Gastritis 1

Mnemonics

H Pylori Treatment

  • Triple Therapy: CAMP
    • C – Clarithromycin
    • A/M – Amoxicillin or Metronidazole
    • P – PPI
  • Quadruple Therapy: TB caMP
    • T – Tetracycline
    • B – Bismuth
    • MP – Same from Triple CAMP

References

  1. Tatsis V, Peponi E, Papadopoulos G, Tsekeris P, Fatouros M, Glantzounis G. Subtotal gastrectomy for diffused hemorrhagic gastritis induced by radiation, following liver resection for hilar cholangiocarcinoma. A case report. Int J Surg Case Rep. 2016;18:30-2. (License: CC BY-NC-ND-4.0)