Gastritis

Published on 31/05/2015 by admin

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Last modified 22/04/2025

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Chapter 24 Gastritis

INTRODUCTION

Description: Gastritis is an inflammatory condition affecting the stomach lining that results in acute or chronic indigestion, bloating, “gas,” and heartburn.
Prevalence: Common.
Predominant Age: Any.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Generalized inflammation of the stomach lining, which, in some cases, may be infectious (Helicobacter pylori).
Risk Factors: Cigarette smoking, alcohol abuse, some medications (nonsteroidal anti-inflammatory drugs [NSAIDs]), bile reflux, radiation.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Nausea, vomiting, dyspepsia, heartburn, and “gas” (symptoms are most common after eating large meals, consuming certain foods)
• Upper abdominal pain or tenderness
• Hiccups

DIAGNOSTIC APPROACH

Differential Diagnosis

• Gastrointestinal reflux
• Ulcer disease (gastric or duodenal)
• Esophageal cancer
• Linitis plastica

Associated Conditions: Bleeding, dysphagia, and gastric or duodenal ulcer.

Workup and Evaluation

Laboratory: No evaluation indicated.
Imaging: No imaging indicated.
Special Tests: Gastroscopy (with or without biopsy) establishes the diagnosis but most often is not necessary.
Diagnostic Procedures: History and physical examination (suspicious), gastroscopy (diagnostic).

Pathologic Findings

Patchy erythema of the gastric mucosa (seldom full thickness) most common in the pyloric antrum.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Dietary changes, elevation of the head of the bed, smoking cessation, alcohol in moderation only, antacids. (Antacids that coat [liquids] and those that tend to float on the surface of the stomach contents, such as Gaviscon, give better heartburn relief than other agents.)
Specific Measures: Eliminate medications that contribute to reduced esophageal pressure, such as diazepam and calcium channel blockers, or that may damage the esophagus (nonsteroidal anti-inflammatory drugs). Use acid-blocking therapy.
Diet: No specific dietary changes indicated.
Activity: No restriction.
Patient Education: Reassurance, diet counseling, behavior modification.

Drug(s) of Choice

Antacids.
Histamine H2 antagonists (cimetidine 800 mg two times daily, ranitidine 400 mg four times daily, famotidine 20 mg two times daily, or nizatidine 150 mg two times daily).
Hydrogen potassium pump blocker (omeprazole 20 to 40 mg daily for 4 to 8 weeks, esomeprazole 20 to 40 mg daily for 4 to 8 weeks, or pantoprazole 40 mg daily for 8 weeks). Misoprostol (Cytotec, 100 to 200 microg PO four times daily) if mucosal injury is documented or suspected.
Contraindications: Known or suspected hypersensitivity. Misoprostol is contraindicated during pregnancy and lactation.
Precautions: If bismuth is prescribed, warn the patient about black stools. Because of a lack of long-term follow-up, hydrogen pump inhibitors may be taken for only 8 to 12 weeks.
Interactions: Multiple drug interactions are possible with agents such as cimetidine; check full prescribing information.

Alternative Drugs

In patients with H. pylori infection, a combination of bismuth (Pepto-Bismol) and an antibiotic (metronidazole 250 mg every 6 hours, tetracycline 500 every 6 hours, or amoxicillin 500 mg every 8 hours) has been recommended for 2 weeks. A 4-week treatment with clarithromycin (Bixin) and either omeprazole (Prilosec) or ranitidine bismuth citrate (Tritec) may also be used.

FOLLOW-UP

• Patient Monitoring: Normal health maintenance. If significant gastric erosion is documented, repeat gastroscopy after 6 weeks is often recommended.
• Prevention/Avoidance: Reduction of modifiable risk factors (e.g., smoking).
• Possible Complications: Chronic pain, ulcer formation, and perforation.
• Expected Outcome: Generally good symptomatic relief, but long-term therapy is often required.

MISCELLANEOUS

• Pregnancy Considerations: No direct effect on pregnancy, although severe gastritis may interfere with maternal nutrition.
• ICD-9-CM Codes: 535.5 (others based on cause).

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REFERENCES

Level II

de Martel C, Parsonnet J. Helicobacter pylori infection and gender: a meta-analysis of population-based prevalence surveys. Dig Dis Sci. 2006;51:2292. Epub 2006 Nov 7

Graham DY, Malaty HM, Evans DG, et al. Epidemiology of Helicobacter pylori in an asymptomatic population in the US. Gastroenterology. 1991;100:1495.

Israel DA, Peek RMJr. The role of persistence in Helicobacter pylori pathogenesis. Curr Opin Gastroenterol. 2006;22:3.

Level III

Feldman M, Burton ME. Drug therapy: histamine2-receptor antagonists—Standard therapy for acid-peptic disease. N Engl J Med. 1990;323:1672. 1749.

Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet. 2006;367(9528):2086.

Panteris V, Karamanolis DG. Different aspects in functional dyspepsia. Hepatogastroenterology. 2005;52:1782.

Rapkin AJ, Mayer EA. Gastroenterologic causes of chronic pelvic pain. Obstet Gynecol Clin North Am. 1993;20:663.

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