Clinical suspicion arises with symptoms of epigastric pain
Diagnosis and classification into types is made by endoscopy
coupled with biopsy.
Acute erosive gastritis
Infiltration of the lamina propria with inflammatory cells
accompanied by superficial erosions that may be diffuse or localized.
Unlike ulcers erosions are superficial breaks that do not
extend deeper than the mucosa itself.
1. Bleeding erosions:
conservative measures + antacids and H2 receptor antagonists
1. If localized ? endoscopic therapy
2. If diffuse vasopressin may be given iv or intra-arterially.
Chronic nonerosive gastritis
There are three pathological stages of mucosal damage
Chronic superficial gastritis with lymphocyte and plasma
cell infiltration of the superficial mucosa
Atrophic gastritis with the development of deeper inflammation,
loss of parietal and chief cells and occasionally intestinal metaplasia.
Gastric atrophy with little evidence of inflammation but
with thinning of the mucosa, loss of gastric glands and intestinal metaplasia
which may be premalignant.
Type A (fundal gastritis)
Type A is usually due to autoimmune and affects the fundus
and body. It is associated with circulating antibodies to parietal cells
and intrinsic factor. It is seen in pernicious
anemia, thyroid disease
and diabetes. Maybe associated atrophy.
Associated with decreased basal acid secretion and hypergastrinemia
+ decreased intrinsic factor secretion.
No specific therapy exists, symptomatic.
Type B (antral)
Not associated with atrophic gastritis; however, it is associated
with both peptic ulcer and Helicobacter pylori.
Treatment depends on the eradication of Helicobacter pylori
infection and symptomatic therapy.
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