Summary
Definition
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
- fever
- altered reflexes or sensory deficits
- cognitive impairment
- glossitis
- coexisting autoimmune disease
Risk factors
- Helicobacter pylori infection
- nonsteroidal anti-inflammatory drug (NSAID) use
- alcohol use/toxic ingestions
- previous gastric surgery
- critically ill patients
- autoimmune disease
- immunocompromise
- infected peritoneojugular venous shunt
- North European or Scandinavian ancestry
Diagnostic tests
1st tests to order
- Helicobacter pylori urea breath test
- Helicobacter pylori fecal antigen test
- CBC
Tests to avoid
- serology
Tests to consider
- endoscopy
- Helicobacter pylori rapid urease test
- gastric mucosal histology
- serum vitamin B12
- upper gastrointestinal (GI) contrast series
- blood/fluid cultures
- parietal cell antibodies
- intrinsic factor antibodies
Treatment algorithm
at risk of stress gastritis
Helicobacter pylori associated
erosive
autoimmune
bile reflux
phlegmonous gastritis
Contributors
Authors
Eli D. Ehrenpreis, MD, FACG, AGAF
Associate Director for Research
Internal Medicine Residency
Advocate Lutheran General Hospital
Park Ridge
IL
Disclosures
EDE declares that he has no competing interests.
Nick Adimi, MD, MS
Internal Medicine Resident
Department of Medicine
Advocate Lutheran General Hospital
Park Ridge
IL
Disclosures
NA declares that he has no competing interests.
Acknowledgements
Dr Eli D. Ehrenpreis and Dr Nick Adimi would like to gratefully acknowledge Dr Nicole Marie Gentile, Dr Parakkal Deepak, and Dr Elad Eichenwald, previous contributors to this topic.
Disclosures
NMG, PD, and EE declare that they have no competing interests.
Peer reviewers
Shazia Siddique, MD, MSHP
Assistant Professor of Medicine
Division of Gastroenterology
University of Pennsylvania
Philadelphia
PA
Disclosures
SS declares that she has no competing interests.
Anthony Axon, MB, BS, MD, FRCP
Professor and Consultant Gastroenterologist
Department of Gastroenterology
Leeds General Infirmary
Leeds
UK
Disclosures
AA is the author of studies referenced in this topic.
References
Key articles
Glickman JN, Antonioli DA. Gastritis. Gastrointest Endosc Clin N Am. 2001 Oct;11(4):717-40. Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Peptic ulcer disease (PUD)
- Gastroesophageal reflux disease (GERD)
- Nonulcer dyspepsia
More DifferentialsGuidelines
- ACG clinical guideline: treatment of Helicobacter pylori infection
- Management of Helicobacter pylori infection
More GuidelinesPatient information
Peptic ulcers
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