Updated: 12/11/2021

Gastritis

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  • 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
          • due to NSAID use, alcohol, severe illness, or H. pylori infection
        • chronic gastritis
          • atrophic gastritis
            • due to autoantibodies to gastric parietal cells
          • nonatrophic gastritis
            • due to NSAID use, alcohol, or other factors
    • 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
          • loss of parietal cells
          • atrophy of gastric mucosa
        • nonatrophic gastritis
          • inflammation of gastric mucosa
  • Presentation
    • History
      • may be asymptomatic
      • sudden-onset nausea
      • vomiting
      • hematemesis
      • melena
      • bloating
    • Symptoms
      • common symptoms
        • location
          • epigastric pain
        • aggravating factor
          • NSAID use
          • alcohol use
    • 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
          • all patients
          • most accurate test
        • findings
          • inflammation of gastric mucosa
          • erosions
          • ulcers
      • urease breath test
        • indication
          • test for H. pylori
          • used to diagnose and confirm eradication of the infection
      • H. pylori stool antigen test
        • indication
          • test for H. pylori
          • used to diagnose and confirm eradication of the infection
    • Histology
      • biopsy from endoscopy
        • findings
          • atrophy
          • chronic inflammation
          • intestinal metaplasia
  • 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
          • indication
            • all patients
      • proton-pump inhibitors or H2 blockers
        • indication
          • all patients except those with atrophic gastritis
          • prophylaxis for patients at risk for stress ulcers
            • head trauma
            • intubation
            • burns
            • coagulopathy
      • H. pylori eradication therapy
        • indication
          • H. pylori positive disease
        • modalities
          • triple therapy
            • proton pump inhibitor
            • clarithromycin
            • amoxicillin or metronidazole
          • quadruple therapy
            • proton pump inhibitor
            • bismuth subcitrate
            • metronidazole
            • tetracycline
      • vitamin B12 supplementation
        • indication
          • atrophic gastritis
  • Complications
    • Gastric cancer
    • Gastrointestinal bleeding

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(M2.GI.16.4694) A 38-year-old man presents to his gastroenterologist after being referred by his primary care physician (PCP). He has had intractable epigastric pain for the last 3 months following meals. His PCP prescribed him a course of ranitidine. After his symptoms did not resolve he was prescribed omeprazole. However, his symptoms persisted and he was referred to gastroenterology. The man undergoes an endoscopy, which finds a gastric ulcer (Figure A). Biopsy with silver staining is shown in Figure B. Which of the following is the most effective regimen for the treatment of this condition?

QID: 107883
FIGURES:

Omeprazole, metronidazole, tetracycline, bismuth

78%

(7/9)

Omeprazole, penicillin, ranitidine

11%

(1/9)

Amoxicillin, clarithromycin

11%

(1/9)

Pantoprazole

0%

(0/9)

Pantoprazole and levofloxacin

0%

(0/9)

M 7 E

Select Answer to see Preferred Response

(M2.GI.16.73) A 35-year-old woman returns to her primary care physician for follow up after treatment for a peptic ulcer. She was diagnosed with a duodenal ulcer and gastritis; endoscopy and biopsy with Warthin Starry staining at the time of diagnosis showed the following (Figure A). She has completed a course with amoxicillin, clindamycin, and omeprazole. The patient reports resolution of symptoms. What is the next best step in management for this patient?

QID: 106564
FIGURES:

Discontinue antibiotics, but continue proton pump inhibitor

8%

(1/12)

Schedule an endoscopy to biopsy duodenal ulcer

17%

(2/12)

Evaluate serum IgG and IgA against H. pylori

0%

(0/12)

Perform a urease breath test

58%

(7/12)

Discontinue therapy, as the patient has completed triple therapy and is not asymptomatic

17%

(2/12)

M 8 D

Select Answer to see Preferred Response

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