The incidence of H pylori
infection increases with age.
No sexual predilection exists.
Autoimmune gastritis
is a relatively rare
disease
PATHOPHYSIOLOGY
certain drugs; alcohol; bile;
ischemia; bacterial, viral, and fungal
infections; acute stress (shock);
radiation; allergy and food poisoning;
and direct trauma.
The common mechanism of injury is
an imbalance between the
aggressive and the defensive factors
that maintain the integrity of the
gastric lining (mucosa).
the major mechanism of
injury is the reduction in
prostaglandin synthesis.
Bacterial infection is another
cause of acute gastritis. The
corkscrew-shaped bacterium
called H pylori is the most
common cause of gastritis
H pylori gastritis typically starts as
an acute gastritis in the antrum,
causing intense inflammation, and
over time, it may extend to involve
the entire gastric mucosa resulting
in chronic gastritis
Antigen-presenting cells
activate lymphocytes and
other mononuclear cells
that lead to chronic
superficial gastritis
H pylori produces
inflammation via the
production of a number of
toxins and enzymes
Ulcero-hemorrhagic gastritis is
most commonly seen in patients
who are critically ill.
Ulcero-hemorrhagic gastritis is
believed to be secondary to
ischemia related to hypotension
and shock
CLINICAL PRESENTATION
Gnawing or burning epigastric
distress, occasionally accompanied
by nausea and/or vomiting. The pain
may improve or worsen with eating
The physical examination
findings are often normal with
occasional mild epigastric
tenderness
DIAGNOSIS
CBC count to assess
for anemia, as acute
gastritis can cause
gastrointestinal
bleeding
Stool for blood
A number of H
pylori tests are
available
Endoscopy may reveal a thickened, edematous,
nonpliable wall with erosions and reddened
gastric folds.
TREATMENT
Administer medical therapy
as needed, depending on
the cause and the
pathological findings
In patients with persistent H pylori infection
despite appropriate initial treatment, a proton
pump inhibitor (PPI), levofloxacin, and
amoxicillin for 10 days appear to be more
effective and better tolerated than a PPI,
bismuth, tetracycline, and metronidazole
Administer fluids and
electrolytes as required,
particularly if the patient is
vomiting
Discontinue the
use of drugs known
to cause gastritis