Gastritis

Gastritis

Pathophysiology
1. acute gastritis
  1. ingest noxious agents (food, drugs, & chemicals) --> break down of gastric mucosal barrierand inhibit prostagalndin production --> epithelial cells are unprotected
    1. Gastric aid and digestive enzymes invade the gastric mucosa --> inflammatory reaction
2. chronic gastritis
  1. H. pylori attaches to foveolar epithelium --> causes epithelial degeneration --> cells change shape--> decrease in apical mucin --> small gasps form in epithelium
    1. intence neurophilic and monomuclear inflammation
    2. atrophy of gastric gland and mucosal thickening --> grey or greenish gray patches appear
    3. disrupt metaplasia --> loss of stomach mucous cells in lining --> blood vessel exposure --> bleeing
Epidemiology
1. 50% of the world population is infected with H. Pylori
2. more common in Asians and Hispanics
3. affects all ages
4. male = female
5. incidence of H. pylori increases with age
Clinical Presentation
1. epigastric discomfort, often aggravated by eating
2. epigastric burning
3. anorexia
4. nausea, with or without vomiting
5. hiccups
6. bloating and/or abdominal fullness
7. bleeding (associated with hemorrhagic gastritis)
Etiology
1. Bacterial infection (H. Pylori)
2. alcohol
3. aspirin or other NSAIDs
4. Bile reflux
5. Pancreatic enzyme reflux
6. Stress (hypovolemia or hypoxia)
7. Radiation
8. Staphylococcus aureus exotoxins
9. viral infection
10. Pernicious anemia
11. Gastric mucosal atrphy
12. Portal hypertensive gastropathy
13. emotional stress
Diagnostics
1. history and physical (presenting signs and symptoms)
2. Laboratory data
  1. measuring ratio of pepsinogen I to pepsinogen II
  2. CMP/CBC (anemia)
  3. c-urea breath test
  4. stool analysis
3. Endoscopy (EGD) with biopsy
Treatment
1. Pharmacological treatment
  1. H. Pylori
    1. Proton pump inhibitor
    2. H2 blockers
    3. antibiotics
    4. ismuth salts
    5. antacids
  2. other nutritional or herbal supplements
    1. vitamins (ultivitamin, vitamin A, C, & D, B vitamins, and trace minerals)
    2. probiotics
    3. Omega-3 fatty acids
    4. cranberries & peppermint
    5. mastic (Pistacia lentiscus)
    6. DGL-licorice (Glycyrrhiza glabra)
  3. Avoid noxious drugs (NSAIDS)
2. lifestyle modifications
  1. smoking cessation
  2. avoid alcohol
  3. avoid caffeine
  4. decrease stress
  5. small bland meals
Risk Factors
1. Over 60 years of age
2. exposure to potentially noxious drugs or chemical agents
  1. NSAIDs
  2. alcohol
  3. Tobacco use
3. Hypovolemia
4. hypoxia
5. Autoimmune disease
  1. Thyroid
  2. diabetes mellitus type I
6. family history of H. Pylori and/or gastric cancer
7. emotional stress

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