Gastritis

Gastritis is the histological presence of gastric mucosal inflammation. Helicobacter pylori infection and use of non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol are the most common causes. Other causes include stress (secondary to mucosal ischaemia) and autoimmune gastritis. Rare forms include phlegmonous gastritis (a rare bacterial infection).

Diagnosis is based on clinical history and characteristic histological findings. A variety of methods may be used to diagnose H pylori infection.

Presence of suspicious features suggestive of upper gastrointestinal (GI) malignancy requires urgent endoscopy under appropriate clinical conditions. These include GI bleeding, anaemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting.

Treatment depends on the aetiology. Options include H pylori-eradication therapy, reduction of NSAIDs or alcohol exposure, and symptomatic therapy with H2 antagonists or proton-pump inhibitors (PPIs).

If untreated, progression to peptic ulcer disease may occur. Other complications of some forms of gastritis include gastric cancer and gastric lymphoma.

Gastritis is defined as the histological presence of gastric mucosal inflammation. The broader term gastropathy encompasses lesions characterised by minimal or no inflammation.​[1]Laine L, Weinstein WM. Subepithelial hemorrhages and erosions of human stomach. Dig Dis Sci. 1988 Apr;33(4):490-503. http://www.ncbi.nlm.nih.gov/pubmed/3280275?tool=bestpractice.com [2]Glickman JN, Antonioli DA. Gastritis. Gastrointest Endosc Clin N Am. 2001 Oct;11(4):717-40. http://www.ncbi.nlm.nih.gov/pubmed/11689363?tool=bestpractice.com

H pylori infection may cause both acute and chronic gastritis.[3]Chey WD, Howden CW, Moss SF, et al. ACG clinical guideline: treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2024 Sep 1;119(9):1730-53. https://journals.lww.com/ajg/fulltext/2024/09000/acg_clinical_guideline__treatment_of_helicobacter.13.aspx http://www.ncbi.nlm.nih.gov/pubmed/39626064?tool=bestpractice.com ​ Erosive gastritis may occur in response to NSAIDs, alcohol use or misuse, and bile reflux into the stomach that may follow previous gastric surgery or cholecystectomy.​[1]Laine L, Weinstein WM. Subepithelial hemorrhages and erosions of human stomach. Dig Dis Sci. 1988 Apr;33(4):490-503. http://www.ncbi.nlm.nih.gov/pubmed/3280275?tool=bestpractice.com [2]Glickman JN, Antonioli DA. Gastritis. Gastrointest Endosc Clin N Am. 2001 Oct;11(4):717-40. http://www.ncbi.nlm.nih.gov/pubmed/11689363?tool=bestpractice.com [4]Bondurant FJ, Maull KI, Nelson HS Jr, et al. Bile reflux gastritis. South Med J. 1987 Feb;80(2):161-5. http://www.ncbi.nlm.nih.gov/pubmed/3810208?tool=bestpractice.com [5]Niemala S. Duodenogastric reflux in patients with upper abdominal complaints or gastric ulcer with particular reference to reflux-associated gastritis. Scand J Gastroenterol Suppl. 1985;115:1-56. http://www.ncbi.nlm.nih.gov/pubmed/3863229?tool=bestpractice.com [6]Niemala S, Karttunen T, Heikkila J, et al. Characteristics of reflux gastritis. Scand J Gastroenterol. 1987 Apr;22(3):349-54. http://www.ncbi.nlm.nih.gov/pubmed/3589504?tool=bestpractice.com [7]McAlhany JC Jr, Hanover TM, Taylor SM, et al. Long-term follow-up of patients with Roux-en-Y gastrojejunostomy for gastric disease. Ann Surg. 1994 May;219(5):451-5. http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1243166&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/8185395?tool=bestpractice.com ​​​ Stress gastritis, most commonly related to mucosal ischaemia seen in critically ill patients, represents a continuum of disease ranging from superficial (erosions) to deep mucosal damage known as stress ulceration.[8]Martindale RG. Contemporary strategies for the prevention of stress-related mucosal bleeding. Am J Health Syst Pharm. 2005 May 15;62(10 Suppl 2):S11-7. http://www.ncbi.nlm.nih.gov/pubmed/15905595?tool=bestpractice.com Autoimmune gastritis is a diffuse form of mucosal atrophy characterised by auto-antibodies to parietal cells and intrinsic factor resulting in inflammatory infiltration and atrophy of the corpus mucosa.[2]Glickman JN, Antonioli DA. Gastritis. Gastrointest Endosc Clin N Am. 2001 Oct;11(4):717-40. http://www.ncbi.nlm.nih.gov/pubmed/11689363?tool=bestpractice.com [9]Kekki M, Siurala M, Varis K, et al. Classification principles and genetics of chronic gastritis. Scand J Gastroenterol Suppl. 1987;141:1-28. http://www.ncbi.nlm.nih.gov/pubmed/3481655?tool=bestpractice.com ​​​ Phlegmonous gastritis is a rare but life-threatening infection of the gastric submucosa and muscularis propria seen in immunocompromised patients.[10]Shipman PJ, Drury P. Emphysematous gastritis: case report and literature review. Australas Radiol. 2001 Feb;45(1):64-6. http://www.ncbi.nlm.nih.gov/pubmed/11259977?tool=bestpractice.com [11]Dharap SB, Ghag G, Biswas A. Acute necrotizing gastritis. Indian J Gastroenterol. 2003 Jul-Aug;22(4):150-1. http://www.ncbi.nlm.nih.gov/pubmed/12962444?tool=bestpractice.com [12]Carlson AP, Chan WH, Ketai LH, et al. Emphysematous gastritis in a severely burned patient: case report and literature review. J Trauma. 2007 Mar;62(3):765-7. http://www.ncbi.nlm.nih.gov/pubmed/17414363?tool=bestpractice.com [13]Loi T, See JY, Diddapur RK, et al. Emphysematous gastritis: a case report and a review of literature. Ann Acad Med Singapore. 2007 Jan;36(1):72-3. http://www.ncbi.nlm.nih.gov/pubmed/17285190?tool=bestpractice.com