Gastritis

Prof. Dr. Aliaa Aly El Aghoury

Professor of Internal Medicine
Endocrinology Unit
Faculty of Medicine, Alex. University
Gastritis

Gastritis is a histologic diagnosis, although it

can sometimes be recognized at endoscopy.
Gastritis

Acute gastritis
Acute gastritis: is often erosive and haemorrhagic.
Gastritis

Causes:
Aspirin, NSAIDs
H. pylori (initial infection)
Alcohol
Severe physiological stress
Bile reflux, e.g. following gastric surgery
Viral infections
Gastritis

Clinical Picture:
Acute gastritis often produce no symptoms, but
may cause dyspepsia, anorexia, nausea or
vomiting and haematemesis or melena.
Gastritis

Investigations:
Many cases resolve quickly and do not need
investigation.
Endoscopy & Biospy 0 to exclude peptic ulcer
or cancer.
Gastritis

Treatment:
Treatment of underlying cause
Antacids
Acid suppression using proton pump inhibitors
or antiemetics (e.g. metochlopramide).
Gastritis

Chronic gastritis
Gastritis

Causes:
Chronic non
non--specific gastritis
H. pylori infection
Autoimmune (pernicious anaemia)
Post
Post--gastrectomy
Gastritis

Treatment:
Most patients are asymptomatic and do not
require any treatment.
H. pylori eradication in dyspepsia.
Gastritis

Peptic Ulcer disease

Gastritis

The term peptic ulcer refers to an ulcer in the

lower oesophagus, stomach or duodenum.
Ulcers in the stomach or duodenum may be
acute or chronic, both penetrate the muscularis
mucosae but the acute ulcer shows no evidence
of fibrosis.
N.B:
Erosions do not penetrate the muscularis mucosae.
Gastritis

Gastric and duodenal ulcer

Gastritis

The prevalence of peptic ulcer is decreasing as

a result of widespread use of H. pylori
eradication therapy.
Around 90% of duodenal ulcer patients and 70%
of gastric ulcer patients are infected with H.
pylori, the remaining are due to NSAIDs.
Gastritis

Aetiology:
1. Helicobacter pylori:
It is gram negative spiral bacteria and has multiple
flagella at one end which make it motile allowing it
to burrow and live deep beneath the mucus layer
closely adherent to the epithelial surface.
Gastritis

The bacteria produce the enzyme urease.

Many different diagnostic tests for H. pylori
infection are available.
Some are invasive and require endoscope.
Others are non invasive.
They vary in sensitivity and specificity.
Overall breath tests are the best.
Gastritis

2. NSAIDs: by depleting mucosal prostaglandin

causing mucosal injury, erosions and
ulceration.
3. Smoking
4. Acid
Acid--pepsin versus mucosal resistance.
Gastritis

Clinical Picture:
1. Recurrent abdominal pain which is
- localized to the epigastrium
- related to food
- occur in episodes
2. Vomiting in 40% of patients (persistent
vomiting suggests gastric outlet obstruction).
Gastritis

3. History of treatment with NSAIDs is sometimes

present especially in elderly.
4. Anorexia and nausea
5. Silent ulcer present with anaemia from chronic
undetected blood loss.
6. Haematemesis
Gastritis

Investigation:
1. Endoscopy
2. Biopsy if malignant ulcer is suspected.
Gastritis

Management:
Aims:
Relieve symptoms
Induce healing
Prevent recurrence
Gastritis

1. H. pylori eradication
1. Proton pump inhibitor
2. Plus two antibiotics (From Amoxicillin,
clarithromycin and metronidazole). For 7 days,
success is achieved in >90% of patients.
Gastritis

Patients who remain infected the choice is

either quadruple therapy (bismuth, proton
pump and 2 antibiotics) on long term
maintenance
i t therapy
th with
ith acid
id suppression.
i
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2. General measures:
Avoid cigarette smoking, Aspirin and NSAIDs.
Gastritis

3. Surgical treatment
Partial gastrectomy in chronic non healing
gastric ulcer.
Gastritis

Complications of peptic ulcer disease

1. Perforation
2. Gastric outlet obstruction
3. Bleeding
Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023