Gastritis - upper GI Flashcards
(15 cards)
What is gastritis?
histological presence of gastric mucosal inflammation.
The broader term gastropathy encompasses lesions characterised by minimal or no inflammation
What is the aetiology of gastritis?
-
Helicobacter pylori infection may cause both an acute and chronic gastritis.
- Acute non-erosive gastritis is most commonly due to H Pylori
- Chronic H pylori infection predisposes to atrophic gastritis and autoimmune gastritis.
- Erosive gastritis may occur in response to NSAID/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 ischaemia 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 characterised by auto-antibodies 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
How is gastritis classified?
Based on aetiology
.Name the risk factors for gastritis?
- Helicobacter pylori infection
- NSAID use
- alcohol use/toxic ingestions
- prior gastric surgery
- critically ill patients
- autoimmune disease
weak
- immunocompromised
- N European
Summarise the epidemiology of gastritis
Data for the incidence and prevalence of gastritis are not available.
- Dyspeptic symptoms are reported in 10% to 20% of patients taking NSAIDs, although the prevalence may range from 5% to 50%.
- non-ulcer dyspepsia (including gastritis) contributes to the diagnosis in about 50% of patients referred for upper endoscopy
What are the presenting symptoms of gastritis?
-
dyspepsia/epigastric discomfort
- non-specific symptom
-
no red flag symptoms for malignancy
- very low risk for <70yrs
- nausea
- vomiting
- loss of appetite
uncommon
-
severe emesis
- phlegmonous gastritis
- acute abdominal pain
- fever
What are the red flag symptoms for GI malignancy?
- gastrointestinal (GI) bleeding
- anaemia
- early satiety
- unexplained weight loss (>10% body weight)
- progressive dysphagia
- odynophagia
- \persistent vomiting
What are the signs of gastritis O/E?
uncommon
-
altered reflexes or sensory deficits
- Patients may have signs and symptoms consistent with clinical vitamin B₁₂ deficiency
- pernicious anaemia due to chronic gastric inflammation and mucosal atrophy in older people, or autoimmune atrophic gastritis
-
cognitive impairment
- see above
-
glossitis
- see above
- or the ‘fiery red tongue’ associated with pernicious anaemia
-
co-existing autoimmune disease
- autoimmune gastritis may have manifestations of associated autoimmune disease (e.g., thyroid disease, idiopathic adrenocortical insufficiency, vitiligo, type 1 diabetes mellitus, and hypoparathyroidism
Name the primary investigations for ?gastritis?
-
Helicobacter pylori urea breath test
- can also be used to monitor response to therapy.
-
H pylori faecal antigen test
- can also be used to monitor response to therapy.
- bloods: FBC
- variable
- may show reduced Hb and HCT + increased <cv>
</cv><li>leukocytosis with left shift in phlegmonous gastritis</li>
Which factors can interfere with the H Pylori breath test?
- Proton-pump inhibitors (PPIs)
- bismuth
- antibiotics
It is generally recommended that, in the post-treatment setting, PPIs are withheld for 7-14 days and antibiotics and bismuth withheld for at least 28 days prior to use of the urea breath test to assess H pylori eradication
What are some secondary investigations for gastritis?
endoscopy
- Consider in patients with symptoms that are refractory to treatment
- Patients with confirmed pernicious anaemia should undergo endoscopy to evaluate for any associated gastric malignancy
H pylori rapid urease test
- Performed on biopsy tissue obtained during endoscopy
- not regularly relied on as there are the breath + stool tests
gastric mucosal histology
- Provides histological diagnosis and classification of gastritis
bloods: B12
- low or normal in autoimmune gastritis
upper GI contrast series
- less useful for diagnosis of gastritis.
- confirmation of phlegmonous gastritis may be obtained from a plain upper GI contrast series and/or CT
blood/fluid cultures
- Recommended if phlegmonous gastritis is suspected
- Cultures of blood and gastric aspirates are performed
parietal cell antibodies
- Present in about 90% of patients with atrophic gastritis
- positive in autoimmune gastritis
intrinsic factor antibodies
- Highly sensitive for pernicious anaemia
- positive in autoimmune gastritis
Explain the management plan for gastritis
What is an emerging test for ?gastritis
H pylori culture/PCR
- Performed on biopsy tissue obtained during endoscopy
- High sensitivity and specificity for H pylori infection
- although less sensitive than rapid urease testing
- less routinely available
Name some possible complications of gastritis
+ vitamin B12 defiency
+ peptic ulcer diease
Summarise the prognosis of gastritis
