Gastritis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Gastritis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Gastritis]]
{{CMG}} {{AE}} {{ARK}}
{{CMG}} {{AE}} {{ARK}}


==Overview==
==Overview==
Gastritis must be differentiated from peptic ulcer disease, gastric cancer, gastroesophageal reflux disease, gastroenteritis, and Crohn's disease.
Gastritis must be differentiated from [[peptic ulcer disease]], [[Stomach cancer|gastric cancer]], [[gastroesophageal reflux disease]] ([[Gastroesophageal reflux disease|GERD]]), [[gastroenteritis]], [[crohn's disease]], [[gastrinoma]], [[gastric adenocarcinoma]] and primary gastric lymphoma.


==Differentiating Gastritis from other Diseases==
==Differentiating Gastritis from other Diseases==
Differentiating Gastritis from other Diseases:
Differentiating gastritis from other Diseases:
*'''Acute Gastritis'''
*'''Acute Gastritis'''
**[[Crohn's Disease]]
**[[Crohn's Disease]]
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**[[Gastroesophageal Reflux Disease]] ([[GERD]])
**[[Gastroesophageal Reflux Disease]] ([[GERD]])
**[[Pernicious Anemia]]
**[[Pernicious Anemia]]
*'''Stress-Induced Gastritis'''
*'''Stress related/induced Gastritis'''
**[[Alcoholic gastropathy]]
**[[Alcoholic gastropathy]]
**Nonsteroidal anti-inflammatory drug, ([[NSAID]])–induced gastritis
**Nonsteroidal anti-inflammatory drug, ([[NSAID]]) induced gastritis
**[[Peptic Ulcer Disease]]
**[[Peptic Ulcer Disease]]
**[[Uremic gastropathy]]
**[[Uremic gastropathy]]
*'''Helicobacter Pylori-Associated Active Gastritis'''
*'''Helicobacter Pylori-associated Gastritis'''
**[[Autoimmune gastritis]]
**[[Autoimmune gastritis]]
**[[Nonspecific chronic inactive gastritis]]
**[[Nonspecific chronic inactive gastritis]]
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**[[Lymphocytic gastritis]]
**[[Lymphocytic gastritis]]
*'''Other differentials'''
*'''Other differentials'''
**[[Ménétrier disease]] (Rare disorder)
**[[Aortic aneurysm]] (ruptured)
**[[Aortic aneurysm]] (ruptured)
**[[Candida]]
**[[Candida]]
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**[[Volvulus]]
**[[Volvulus]]
**[[Zollinger-Ellison Syndrome]]
**[[Zollinger-Ellison Syndrome]]
<br/>
<br />
<br/>
<br />
* '''The table below differentiates Gastritis from other conditions'''
* '''The table below differentiates gastritis from other conditions:'''<ref name="pmid6710074">{{cite journal| author=Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T| title=Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy. | journal=Scand J Gastroenterol | year= 1984 | volume= 19 | issue= 1 | pages= 31-7 | pmid=6710074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6710074  }} </ref><ref name="pmid25901896">{{cite journal| author=Sipponen P, Maaroos HI| title=Chronic gastritis. | journal=Scand J Gastroenterol | year= 2015 | volume= 50 | issue= 6 | pages= 657-67 | pmid=25901896 | doi=10.3109/00365521.2015.1019918 | pmc=4673514 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25901896  }} </ref><ref name="pmid16819502">{{cite journal| author=Sartor RB| title=Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. | journal=Nat Clin Pract Gastroenterol Hepatol | year= 2006 | volume= 3 | issue= 7 | pages= 390-407 | pmid=16819502 | doi=10.1038/ncpgasthep0528 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16819502  }} </ref><ref name="pmid2789799">{{cite journal| author=Sipponen P| title=Atrophic gastritis as a premalignant condition. | journal=Ann Med | year= 1989 | volume= 21 | issue= 4 | pages= 287-90 | pmid=2789799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2789799  }} </ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }} </ref><ref name="pmid17956071">{{cite journal| author=Ramakrishnan K, Salinas RC| title=Peptic ulcer disease. | journal=Am Fam Physician | year= 2007 | volume= 76 | issue= 7 | pages= 1005-12 | pmid=17956071 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17956071  }} </ref><ref name="pmid17985090">{{cite journal| author=Banasch M, Schmitz F| title=Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors. | journal=Wien Klin Wochenschr | year= 2007 | volume= 119 | issue= 19-20 | pages= 573-8 | pmid=17985090 | doi=10.1007/s00508-007-0884-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17985090  }} </ref><ref name="pmid15621988">{{cite journal| author=Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM| title=Gastric adenocarcinoma: review and considerations for future directions. | journal=Ann Surg | year= 2005 | volume= 241 | issue= 1 | pages= 27-39 | pmid=15621988 | doi= | pmc=1356843 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15621988  }} </ref><ref name="pmid21390139">{{cite journal| author=Ghimire P, Wu GY, Zhu L| title=Primary gastrointestinal lymphoma. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 6 | pages= 697-707 | pmid=21390139 | doi=10.3748/wjg.v17.i6.697 | pmc=3042647 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21390139  }} </ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| colspan="13" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}
| colspan="13" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}
|+  
|+  
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| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Alleviating Factors'''}}
| rowspan="1" style="background:#4479BA; padding: 5px 5px;" align="center" |{{fontcolor|#FFF|'''Alleviating Factors'''}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Acute gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Acute gastritis|'''Acute gastritis''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
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* [[Alcohol]]
* [[Alcohol]]
* Spicy food
* Spicy food
* Viral infections
* [[Viral infections]]
* [[Crohn's disease]]
* [[Crohn's disease]]
* [[Autoimmune diseases]]
* [[Autoimmune diseases]]
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|[[Melena|Black stools]]
|[[Melena|Black stools]]
|
|
* Pangastritis or antral [[gastritis]]
* [[Pangastritis]] or antral [[gastritis]]
* [[Gastric erosion|Erosive]] (Superficial, deep, hemorrhagic)
* [[Gastric erosion|Erosive]] (Superficial, deep, hemorrhagic)
* Nonerosive (''[[H. pylori]]'')
* Nonerosive (''[[H. pylori]]'')
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|Chronic gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastritis|'''Chronic gastritis''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Atrophic gastritis|'''Atrophic gastritis''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
* [[Autoimmune disease]]
* [[Autoimmune disease]]
|[[Epigastric pain]]
|
*[[Epigastric pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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**Low serum [[vitamin B12|cobalamine]]
**Low serum [[vitamin B12|cobalamine]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Crohn's disease]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Crohn's disease|'''Crohn's disease''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Autoimmune disease]]
* [[Autoimmune disease]]
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* [[Anemia]] ([[pernicious anemia]])
* [[Anemia]] ([[pernicious anemia]])
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[GERD]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[GERD|'''GERD''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Lower esophageal sphincter abnormalities
* Lower esophageal sphincter abnormalities
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* Abnormal esophageal contractions
* Abnormal esophageal contractions
* Prolonged emptying of [[stomach]]
* Prolonged emptying of [[stomach]]
* [[Gastrinomas]]
* [[Gastrinoma|Gastrinomas]]
|
|
* [[Epigastric pain]]
* [[Epigastric pain]]
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|
|
* [[Esophagitis]]
* [[Esophagitis]]
* Barrette esophagus
* [[Barrette's esophagus]]
* [[Strictures]]
* [[Strictures]]
|Other symptoms:
|Other symptoms:
Line 240: Line 242:
* Barrette esophagus
* Barrette esophagus
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Peptic ulcer disease]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Peptic ulcer disease|'''Peptic ulcer disease''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]''
* ''[[H. pylori]]''
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* [[Radiation therapy]]
* [[Radiation therapy]]
* Medications
* Medications
* Zollinger-ellison syndrome
* [[Zollinger-Ellison syndrome]]
|
|
* [[Epigastric pain]] sometimes extending to back
* [[Epigastric pain]] sometimes extending to back
Line 281: Line 283:
* [[Biopsy]]
* [[Biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastrinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastrinoma|'''Gastrinoma''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Associated with [[MEN type 1]]
* Associated with [[MEN type 1]]
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* [[CT]] and [[MRI]]
* [[CT]] and [[MRI]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric Cancer|Gastric Adenocarcinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric Cancer|'''Gastric Adenocarcinoma''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]'' infection
* ''[[H. pylori]]'' infection
Line 328: Line 330:
* Frequent [[burping]]
* Frequent [[burping]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric lymphoma|Primary gastric lymphoma]]
| style="padding: 5px 5px; background: #DCDCDC;" |[[Gastric lymphoma|'''Primary gastric lymphoma''']]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* ''[[H. pylori]]'' infection
* ''[[H. pylori]]'' infection
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{{WS}}
{{WS}}


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[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Differential diagnosis]]

Latest revision as of 21:49, 29 July 2020

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 must be differentiated from peptic ulcer disease, gastric cancer, gastroesophageal reflux disease (GERD), gastroenteritis, crohn's disease, gastrinoma, gastric adenocarcinoma and primary gastric lymphoma.

Differentiating Gastritis from other Diseases

Differentiating gastritis from other Diseases:



Differential Diagnosis
Disease Cause Symptoms Diagnosis Other findings
Pain Nausea & Vomiting Heartburn Belching or Bloating Weight loss Loss of Appetite Stools Endoscopy findings
Location Aggravating Factors Alleviating Factors
Acute gastritis Food Antacids ✔ ✔ ✔ - ✔ Black stools -
Chronic gastritis Food Antacids ✔ ✔ ✔ ✔ ✔ - H. pylori gastritis

Lymphocytic gastritis

  • Enlarged folds
  • Aphthoid erosions
 -
Atrophic gastritis - - ✔ - ✔ ✔ - H. pylori

Autoimmune

Crohn's disease - - - - - ✔ ✔
  • Mucosal nodularity with cobblestoning
  • Multiple aphthous ulcers
  • Linier or serpiginous ulcerations
  • Thickened antral folds
  • Antral narrowing
  • Hypoperistalsis
  • Duodenal strictures
GERD
  • Spicy food
  • Tight fitting clothing
 ✔

(Suspect delayed gastric emptying)

✔ - - - - Other symptoms:

Complications

Peptic ulcer disease

Duodenal ulcer

  • Pain aggravates with empty stomach

Gastric ulcer

  • Pain aggravates with food
  • Pain alleviates with food
 ✔ ✔ - - - Gastric ulcers
  • Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
  • Most ulcers are at the junction of fundus and antrum
  • 0.5-2.5cm

Duodenal ulcers

Other diagnostic tests
Gastrinoma - - ✔

(suspect gastric outlet obstruction)

✔ - - - Useful in collecting the tissue for biopsy

Diagnostic tests

Gastric Adenocarcinoma - - ✔ ✔ ✔ ✔ ✔ Esophagogastroduodenoscopy
  • Multiple biopsies are taken to establish the diagnosis
 Other symptoms
Primary gastric lymphoma - - - - - ✔ - - Useful in collecting the tissue for biopsy Other symptoms

References

  1. ↑ Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). "Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy". Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.
  2. ↑ Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.
  3. ↑ Sartor RB (2006). "Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis". Nat Clin Pract Gastroenterol Hepatol. 3 (7): 390–407. doi:10.1038/ncpgasthep0528. PMID 16819502.
  4. ↑ Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.
  5. ↑ Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
  6. ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
  7. ↑ Banasch M, Schmitz F (2007). "Diagnosis and treatment of gastrinoma in the era of proton pump inhibitors". Wien Klin Wochenschr. 119 (19–20): 573–8. doi:10.1007/s00508-007-0884-2. PMID 17985090.
  8. ↑ Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM (2005). "Gastric adenocarcinoma: review and considerations for future directions". Ann Surg. 241 (1): 27–39. PMC 1356843. PMID 15621988.
  9. ↑ Ghimire P, Wu GY, Zhu L (2011). "Primary gastrointestinal lymphoma". World J Gastroenterol. 17 (6): 697–707. doi:10.3748/wjg.v17.i6.697. PMC 3042647. PMID 21390139.

Template:WH Template:WS

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