Stomach: Gastritis

Basics

• Definition: Inflammation Associated with Gastric Mucosal Injury
• Multiple Classification Systems Controversial
• Inflammatory Changes
  • Acute – Neutrophilic
  • Chronic – Mixture of Mononuclear Cells (Macrophages, Lymphocytes & Plasma Cells)

Chronic Gastritis

• Type A
  • Cause: Autoimmune – Antibodies to Parietal Cells & Intrinsic Factor
  • Site: Fundus
  • Causes Pernicious Anemia, Achlorhydria & Gastric Atrophy
• Type B
  • Cause: H. pylori Bacteria
  • Site: Antrum Predominantly
• Type C
  • Cause: Chemical Gastritis from NSAIDs, Alcohol or Reflux of Duodenal Contents
    • NSAIDs Inhibit Cyclooxygenase Reducing Mucosal Prostaglandin Synthesis – Causes Reduced Blood Flow & Reduced Bicarbonate/Mucin Secretion
  • Site: Antrum & Body

Stress Gastritis

• Inflammation that Occurs 3-10 Days After a Stress While in the Hospital/ICU
• First Seen in Fundus
• Greatest Risk Factors: Coagulopathy & Prolonged Ventilation
• Stress Ulcer Prophylaxis (SUP) Indications:
  • Major Criteria:
    • Coagulopathy
    • Mechanical Ventilation > 48 Hours
    • History of GI Ulcer/Bleed Within the Last Year
    • TBI, Traumatic Spinal Cord Injury or Burn Injury
  • Minor Criteria (≥ 2):
    • Sepsis
    • ICU Stay > 1 Week
    • Occult GI Bleeding for ≥ 6 Days
    • Steroid Therapy

Diagnosis

• Dx: EGD & Bx

Treatment

• Tx: PPI (Omeprazole or Pantoprazole/Protonix)
  • PPIs are Better Than H2 Blockers (Famotidine/Pepcid)
• H. pylori Tx: Mn
  • Triple Therapy
    • Clarithromycin
    • Amoxicillin/Metronidazole
    • PPI
  • Quadruple Therapy
    • Bismuth
    • Metronidazole
    • Tetracycline
    • PPI
  • Test for Eradication 4 Weeks After Completion of Therapy
    • Best Test: Urea Breath Test
    • Must Hold PPI 2 Weeks Prior to Test