Gastritis is the histological presence of gastric mucosal inflammation.Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs) or alcohol are the most common causes. Other causes include stress (secondary to mucosal ischemia) and autoimmune gastritis. Rare forms include phlegmonous gastritis (a rare bacterial infection).
Diagnosis is based on clinical history and characteristic histologic 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, anemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting.
Treatment depends on the etiology. Options include H pylori-eradication therapy, reduction of NSAIDs or alcohol exposure, and symptomatic therapy with H₂ antagonists and/or proton-pump inhibitors.
If untreated, progression to peptic ulcer disease may occur. Other complications of some forms of gastritis include gastric carcinoma and gastric lymphoma.
Helicobacter pylori infection may cause both an acute and chronic gastritis. Erosive gastritis may occur in response to nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol use or misuse, and to bile reflux into the stomach that may follow previous gastric surgery or cholecystectomy. Stress gastritis, most commonly related to mucosal ischemia seen in critically ill patients, represents a continuum of disease ranging from superficial (erosions) to deep mucosal damage known as stress ulceration. Autoimmune gastritis is a diffuse form of mucosal atrophy characterized by autoantibodies to parietal cells and intrinsic factor resulting in inflammatory infiltration and atrophy of the corpus mucosa. Phlegmonous gastritis is a rare but life-threatening infection of the gastric submucosa and muscularis propria seen in immunocompromised patients.
History and exam
Key diagnostic factors
- dyspepsia/epigastric discomfort
- no suspicious features of malignancy
Other diagnostic factors
- nausea, vomiting, and loss of appetite
- severe emesis
- acute abdominal pain
- altered reflexes or sensory deficits
- cognitive impairment
- coexisting autoimmune disease
- Helicobacter pylori infection
- nonsteroidal anti-inflammatory drug (NSAID) use
- alcohol use/toxic ingestions
- previous gastric surgery
- critically ill patients
- autoimmune disease
- North European or Scandinavian ancestry
1st investigations to order
- Helicobacter pylori urea breath test
- H pylori fecal antigen test
Investigations to consider
- H pylori rapid urease test
- gastric mucosal histology
- serum vitamin B12
- upper GI contrast series
- blood/fluid cultures
- parietal cell antibodies
- intrinsic factor antibodies
- H pylori culture/polymerase chain reaction (PCR)
at risk of stress gastritis
Helicobacter pylori associated
- Peptic ulcer disease (PUD)
- Gastroesophageal reflux disease (GERD)
- Nonulcer dyspepsia
- Informed consent for GI endoscopic procedures
- ACR appropriateness criteria: epigastric pain
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