Gastritis (atrophic)

Question 1

What is atrophic gastritis?

Answer 1

Chronic inflammation of the gastric mucosa with atrophy, gland loss, and metaplastic changes

Question 2

What are the types of atrophic gastritis?

Answer 2

Autoimmune metaplastic atrophic gastritis (AMAG)

Environmental metaplastic atrophic gastritis (EMAG)

Question 3

What are the risk factors of AMAG?

Answer 3

Histocompatibility complex HLA-B8 and HLA-DR3
Autoimmune diseases (e.g. autoimmune thyroiditis)

Question 4

What are the risk factors of EMAG?

Answer 4

Helicobacter pylori infection

Diet high in salt + alcohol + processed meat

Question 5

What is the pathophysiology in AMAG?

Answer 5

Autoimmune destruction of parietal cells → Achlorhydria→ increased gastrin release (due to negative feedback) → G cell hyperplasia → hypergastrinemia → Hypergastrinemia may lead to hyperplasia of enterochromaffin-like cells

Question 6

What is the pathophysiology of EMAG?

Answer 6

Colonization by H. pylori → decreased production of mucins → increased production of gastric acids → inflammation mainly in antrum→ ascending propagation → atrophy of the gastric glands → hypochlorhydria (not achlorhydria) and epithelial metaplasia → increased risk of gastric cancers

Question 7

What are the clinical features of atrophic gastritis?

Answer 7

Hematemesis
Epigastric pain
Nausea + vomiting

Question 8

How is atrophic gastritis diagnosed?

Answer 8

H. pylori test

Esophagogastroduodenoscopy + biopsy

Question 9

What is the treatment for atrophic gastritis?

Answer 9

(General) Reduce alcohol and tobacco
(EMAG) Triple therapy (PPI + clarithromycin + amoxicillin or metronidazole) for eradication of H.pylori
(AMAG)
(Drugs to reduce acid) PPI (e.g. lansoprazole), H2 blockers (e.g. ranitidine)