Snapshot A 55-year-old man presents to his primary care physician for intermittent epigastric pain for the past few months. He reports having sudden-onset nausea and bloating episodes as well. His other past medical history includes chronic back pain, for which he takes ibuprofen regularly. He smokes cigarettes and drinks alcohol on a daily basis. He is prescribed a proton pump inhibitor, instructed to cut back on alcohol, and scheduled for an upper endoscopy. Introduction Overview inflammation of the gastric mucosa often with erosive changes subtypes are acute gastritis login to view 1 more bullet chronic gastritis login to view 4 more bullets Associated conditions atrophic gastritis other autoimmune diseases i.e., pernicious anemia and diabetes mellitus Epidemiology Demographics adults chronic gastritis is very common Risk factors east Asian heritage drug use prior history of H. pylori autoimmune disease ETIOLOGY Pathogenesis mechanism atrophic gastritis login to view 2 more bullets nonatrophic gastritis login to view 1 more bullet Presentation History may be asymptomatic sudden-onset nausea vomiting hematemesis melena bloating Symptoms common symptoms location login to view 1 more bullet aggravating factor login to view 2 more bullets Physical exam palpation may have epigastric tenderness Imaging No imaging indicated Studies Serum labs normal gastrin level vitamin B12 may be decreased in atrophic gastritis H. pylori antibody testing does not distinguish between current or past infection Invasive studies endoscopy indications login to view 2 more bullets findings login to view 3 more bullets urease breath test indication login to view 2 more bullets H. pylori stool antigen test indication login to view 2 more bullets Histology biopsy from endoscopy findings login to view 3 more bullets Differential Zollinger-Ellison syndrome key distinguishing factors symptoms of gastritis that aren’t responsive to therapy elevated serum gastrin levels Treatment Nonoperative lifestyle changes avoid exacerbating agents login to view 2 more bullets proton-pump inhibitors or H2 blockers indication login to view 6 more bullets H. pylori eradication therapy indication login to view 1 more bullet modalities login to view 9 more bullets vitamin B12 supplementation indication login to view 1 more bullet Complications Gastric cancer Gastrointestinal bleeding