Gastritis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]
Overview
Gastritis may be seen as a commonly occurring inflammatory disease in many individuals. Gastritis usually persists throughout life and the chance of spontaneous healing is rare. Gastritis is mostl associated with the presence of Helicobacter pylori infection. The gastric mucosa undergoes inflammation and may lead to atrophic gastritis. Chronic gastritis is a condition which is commonly observed as a manifestation of pathogenesis of many gastric disease conditions. Gastric secretory functions are usually impaired due to the gastric mucosa undergoing inflammation and atrophy. Increase in the prevalence of gastritis is attributed to the increasing age and the onset varies among different ethnicities. The increased risk of developing duodenal and peptic ulcers have been observed in individuals with persistent gastritis. Biopsies and routine evaluations may help predict the progression of gastritis to further conditions such as the peptic ulcer disease. Complications of Gastritis may include, peptic ulcers, gastrointestinal perforation, gastrointestinal bleeding, gastric polyp, anemia due to erosive gastritis, vitamin B12 deficiency, pernicious anemia, gastric outlet obstruction, increased risk of developing benign or malignant growths in the lining of the stomach which may lead to stomach cancer. Prognosis for gastritis is majorly dependent upon the type of gastritis and etiological factors. In Acute gastirtis, the condition improves upon refraining from risk factors such as NSAIDs, alcohol, cigarette smoking, acidic food, and beverages. In Autoimmune gastirtis, prognosis is usually good for vitamin B12 deficiency when treated with cyanocobalamin therapy. Although in Autoimmune gastritis, there is an increased risk for carcinoid tumors and gastric adenocarcinoma. In Chronic gastirtis associated with Helicobacter pylori infection, the prognosis is good. The triple therapy regimen may not be effective when compared to quadruple bismuth-based regimen is has proven to be very effective comparatively. In individuals with Helicobacter pylori infection associated chronic gastritis, if left untreated may progress to develop peptic ulcer disease, adenocarcinoma and MALT lymphoma.
Natural History
Gastritis is a common inflammatory disease. Gastritis usually persists throughout life and the chance of spontaneous healing is rare. Gastritis is most commonly associated with Helicobacter pylori infection. The gastric mucosa undergoes inflammatory changes which may finally lead to atrophic gastritis. Chronic gastritis is commonly observed as a manifestation of progression of many gastric conditions. Gastric secretory functions are usually impaired due to inflammation and atrophy of the gastric mucosa. Increase in the prevalence of gastritis is attributed to the increasing age and the onset varies among different ethnicities. The increased risk of developing duodenal and peptic ulcers have been observed in individuals with persistent gastritis. Biopsies and routine evaluations may help predict the progression of gastritis to the conditions such as the peptic ulcer disease. [1][2][3]
Complications
- Acute gastritis Complications:
- Ulcer bleed
- Bleeding as a result of gastric erosion
- Anemia as a result of the bleeding from the ulcer or due to the gastric erosion
- Gastric outlet obstruction
- Chronic gastritis Complications:
- Atrophic gastritis
- Peptic ulcers
- Gastrointestinal Perforation
- Gastrointestinal Bleeding
- Anemia due to erosive gastritis
- Stomach cancer
- Vitamin B12 deficiency
- Pernicious anemia
- Increased risk of developing benign or malignant growths in the lining of the stomach.
- Atrophic gastritis Complications:
- Atrophic gastirtis as a result of Helicobacter pylori infection:
- Atrophic gastritis as a result of atrophic gastritis due to Autoimmune gastritis:
- Stress Induced gastritis Complications:
- Rarely, stress-induced gastritis may lead to severe bleeding that can prove fatal and leads to a life-threatening situation.
- Helicobacter pylori-associated gastirtis Complications:
- Chronic Helicobacter pylori-associated gastritis increases the risk for mucosa-associated lymphoid tissue (MALT) lymphoma.
- Gastric and duodenal ulcers
- Gastric adenocarcinoma
- Pseudomembranous colitis following H. pylori treatment
- B12 and iron deficiency anemia
- Post Treatment complication of of Helicobacter pylori infection is Clostridium difficile infection
Prognosis
- Prognosis for gastritis is majorly dependent upon the type of gastritis and etiological factors:
- In Acute gastritis, the condition improves upon refraining from risk factors such as NSAIDs, alcohol, cigarette smoking, acidic food, and beverages. [4]
- In Autoimmune gastritis, prognosis is usually good for vitamin B12 deficiency when treated with cyanocobalamin therapy. Although in autoimmune gastritis, there is an increased risk for carcinoid tumors and gastric adenocarcinoma. [5] [6]
- In Chronic gastirtis associated with Helicobacter pylori infection, the prognosis is good.
- The triple therapy regimen may not be effective when compared to quadruple bismuth-based regimen is has proven to be very effective comparatively. [7]
- In individuals with Helicobacter pylori infection associated chronic gastritis, if left untreated may progress to develop peptic ulcer disease, adenocarcinoma and MALT lymphoma.
References
- ↑ Redéen S, Petersson F, Kechagias S, Mårdh E, Borch K (2010). "Natural history of chronic gastritis in a population-based cohort". Scand J Gastroenterol. 45 (5): 540–9. doi:10.3109/00365521003624151. PMID 20180646.
- ↑ Sipponen P, Kekki M, Siurala M (1991). "The Sydney System: epidemiology and natural history of chronic gastritis". J Gastroenterol Hepatol. 6 (3): 244–51. PMID 1912435.
- ↑ Sipponen P (1992). "Natural history of gastritis and its relationship to peptic ulcer disease". Digestion. 51 Suppl 1: 70–5. PMID 1397747.
- ↑ Laine L, Curtis SP, Cryer B, Kaur A, Cannon CP (2010). "Risk factors for NSAID-associated upper GI clinical events in a long-term prospective study of 34 701 arthritis patients". Aliment Pharmacol Ther. 32 (10): 1240–8. doi:10.1111/j.1365-2036.2010.04465.x. PMID 20955443.
- ↑ Burkitt MD, Pritchard DM (2006). "Review article: Pathogenesis and management of gastric carcinoid tumours". Aliment Pharmacol Ther. 24 (9): 1305–20. doi:10.1111/j.1365-2036.2006.03130.x. PMID 17059512.
- ↑ Hsing AW, Hansson LE, McLaughlin JK, Nyren O, Blot WJ, Ekbom A; et al. (1993). "Pernicious anemia and subsequent cancer. A population-based cohort study". Cancer. 71 (3): 745–50. PMID 8431855.
- ↑ Chey WD, Wong BC, Practice Parameters Committee of the American College of Gastroenterology (2007). "American College of Gastroenterology guideline on the management of Helicobacter pylori infection". Am J Gastroenterol. 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.