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-specific gastritis nonH. pylori infection Autoimmune (pernicious anaemia) Post-gastrectomy Post-

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-pepsin versus mucosal resistance. Acid-

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).

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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.

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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.

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Patients who remain infected the choice is either quadruple therapy (bismuth, proton pump and 2 antibiotics) on long term maintenance therapy with acid suppression. i t th ith id i

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2. General measures:
Avoid cigarette smoking, Aspirin and NSAIDs.

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

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Complications of peptic ulcer disease
1. Perforation 2. Gastric outlet obstruction 3. Bleeding

Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023