Main symptoms and

syndromes of gastritis and

peptic ulcer

Department of Propedeutics
of Internal Medicine №1

Kyiv, 2020
 Gastritis
Definition:
■ Inflammation associated with mucosal injury
■ A histological term that needs biopsy to be
confirmed

Classification:
Acute: short term inflammation
Chronic: long standing inflammation with
with cells regeneration disturbances
 Acute Gastritis
Transient mucosal acute inflammation

Frequently associated with:

■ Heavy use of NSAIDs
■ Excessive alcohol consumption
■ Heavy smoking
■ Chemotherapeutic drugs
■ Uremia
■ Severe stress – trauma, burns, surgery
■ Suicidal ingestion of corrosive
■ Nasogastric intubation
 Acute Gastritis

Symptoms:
■ Epigastric pain
■ Nausea & vomiting
■ Massive hematemesis & malena
■ May be asymptomatic
 Acute Gastritis
Inspection: ▪ Pale skin and visible mucous
▪ Grayish-white layering of the tongue

Palpation of abdomen:
▪ pain in the epigastric region

Another symptoms:
▪ Increased body temperature
▪ Frequent pulse
▪ blood pressure decreases (in severe cases - collapse)
ACUTE GASTRITIS

Mucosal congestion, oedema,

inflammation, ulceration and bleeding.
 Chronic Gastritis

chronic mucosal inflammatory-dystrophic

changes with recurrent duration that passing
with cells regeneration disturbances leading to
impairment secretory, motoric and incretory
functions of the stomach
 Etiology of Chronic Gastritis

■ H.Pylori chronic infection

■ Autoimmune
■ Toxic as with alcohol & cigarette smoking
■ Post surgical - antrectomy with gastroenterostomy with
reflux of bile
■ Motorical & mechanical including obstruction, bezoars
& gastric atony
■ Radiation
■ Granulomatous (Сrohn’s disease)
■ Uremia
 Pathogenesis of Chronic
Gastritis

▪ Inflammation
▪ Atrophy
▪ Impairment cells regeneration with
metaplasia and dysplasia
 Chronic Gastritis - Classification
■ Type B - Bacterial: Helicobacter pylori. > 90%
■ Type A - Autoimmune:
■ Atrophic, Pernicious anemia <10%.
■ Antibody to Parietal cell & intrinsic factor.
■ The special forms - Type C – Chemical: Bile reflux, etc.
■ Rare
■ Systemicdiseases – Crohn’s, amyloidosis
■ Radiating
■ Eoshynophyly
 Chronic Gastritis
TYPE A/ IMMUNE GASTRITIS:
■ Site: cardial part and body of stomach
■ Antibodies against parietal cells, intrinsic factor – hypo-achlorhydria,
pernicious anemia
■ Also seen Hashimoto thyroiditis, Addison’s disease, type 1 diabetes
■ Patient are at risk of developing carcinoma / carcinoid tumors

TYPE B/ NON IMMUNE GASTRITIS:

■ Site: begins in antrum and progress proximally to fundus

■ Associated with H. pylori, alcohol, Cigarette smoke
■ Hypersecretory : associated with ↑HCl
 Chronic Gastritis: H. pylori influence
Four important virulence factors:

1. Flagella rapid motility easily penetrate

mucus layer
2. Urease generates ammonia increase local
gastric pH
3. Adhesins enhance bacterial adherence to
surface foveolar cells
4. Toxins (cytotoxin-associated gene A or CagA)
poorly-defined mechanisms
 Chronic Gastritis
■ Main syndromes :
■ Pain (early, connected with meal, epigastric area)
■ Gastric dyspepsia (appetite disorders, nausea,
vomiting, belch, epigastric heaviness, heartburn)
■ Intestinal dyspepsia (diarrhea, constipation -
depending on the type of secretion)
■ Asthenoneurotic (vegetative) – (weakness,
fatigue, sleep and mood disorders irritability)
 Chronic Gastritis
Inspection: ▪ Pale skin and visible mucous
▪ gingival hemorrhage, angular cheilosis
▪ smooth bright crimson tongue
▪ nail fragility, hear loss
▪ Increased /decreased body weight

Palpation of abdomen:
▪ Tenderness / pain in the epigastric region
 Additional examination
■ Blood test
■ H. pylori detection
■ Gastroscopia – gold diagnostic standard
■ Ultrasound examination
■ Intragastral pH-metria
■ EKG
Endoscopic view of uncomplicated erosive gastritis.
The erosion appears as a small, superficial mucosal
break with a black base (arrow).
Helicobacter Pylori Breath
Testing
 PEPTIC ULCER
Ulcer defined as breach in mucosa of
alimentary tract that extends through out the
muscularis mucosa into submucosa or deeper
 PEPTIC ULCER
■ Main syndromes :
■ Pain
■ Dyspepsia (gastric dyspepsia, duodenal
dyspepsia)
■ Intestinal dyspepsia (diarrhea, constipation,
flatulence)
■ Asthenoneurotic (vegetative) – (weakness,
fatigue, sleep and mood disorders irritability)
 PEPTIC ULCER
■ Gastric localization:
■ Early pain (10 min - 1 hour after eating),
epigastric region, intensive, periodic,
gastric
seasonal (spring and autumn)
■ Gastric dyspepsia
■ Intestinal dyspepsia (diarrhea, flatulence)
■ Type of secretion –normal or
hyposecretion, rarer –hypersecretion
 PEPTIC ULCER
■ Duodenum localization:
■ Late pain (1,5-2 hours after eating), night,
fasting, intensive, burning, acute, periodic,
seasonal
■ Duodenal dyspepsia (nausea, vomiting,
belch, heartburning, bloating)
■ Intestinal dyspepsia (constipations)
■ Type of secretion – always hypersecretion
 PEPTIC ULCER
Additional examination
■ Gastroscopia – gold diagnostic standard (Biopsy/
cytology, stains)
■ Blood test
■ Ultrasound examination
■ EKG
■ H. pylori detection
▪ C13 urea breath test – Radioactive – common
▪ H.pylori serology – IgG
▪ Monoclonal antibody test on stool samples.
Specific (98%) and sensitive (94%)
PUD Complications:

■ Bleeding – Anemia
■ Penetration
■ Pyloric stenosis – obstruction
■ Perforation – Peritonitis
■ Malignancy (Gastric carcinoma )