Gastritis differential diagnosis: Difference between revisions

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* [[Volvulus]]
* [[Volvulus]]
* [[Zollinger-Ellison Syndrome]]
* [[Zollinger-Ellison Syndrome]]
==Differential Diagnosis==
Gastritis must be differentiated from:<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>
<div style="width: 85%;">
{| class="wikitable"
! rowspan="3" |Disease
! rowspan="3" |Cause
! colspan="9" |Symptoms
!Diagnosis
! rowspan="3" |Other findings
|-
! colspan="3" |Pain
! rowspan="2" |Nausea
&
Vomiting
! rowspan="2" |Heartburn
! rowspan="2" |Belching or
Bloating
! rowspan="2" |Weight loss
! rowspan="2" |Loss of
Appetite
! rowspan="2" |Stools
! rowspan="2" |Endoscopy findings
|-
!Location
!Aggravating Factors
!Alleviating Factors
|-
![[Acute gastritis]]
|
* ''[[H. pylori]]''
* [[NSAIDS]]
* [[Corticosteroids]]
* [[Alcohol]]
* Spicy food
* Viral infections
* [[Crohn's disease]]
* [[Autoimmune diseases]]
* Bile reflux
* [[Cocaine]] use
* Breathing machine or ventilator
* Ingestion of [[corrosive|corrosives]]
|
* [[Epigastric pain]]
|Food
|[[Antacids]]
|?
|?
|?
|<nowiki>-</nowiki>
|?
|[[Melena|Black stools]]
|
* Pangastritis or antral [[gastritis]]
* [[Gastric erosion|Erosive]] (Superficial, deep, hemorrhagic)
* Nonerosive (''[[H. pylori]]'')
|<nowiki>-</nowiki>
|-
![[Gastritis|Chronic gastritis]]
|
* ''[[H. pylori]]''
* [[Alcohol]]
* Medications
* [[Autoimmune diseases]]
* Chronic stress
|
* [[Epigastric pain]]
|Food
|[[Antacids]]
|?
|?
|?
|?
|?
|<nowiki>-</nowiki>
|''[[H. pylori]] [[gastritis]]''
* [[Atrophy]]
* Intestinal [[metaplasia]]
Lymphocytic gastritis
* Enlarged folds
* Aphthoid erosions
|<nowiki>-</nowiki>
|-
![[Atrophic gastritis]]
|
* ''[[H. pylori]]''
* [[Autoimmune disease]]
|[[Epigastric pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|?
|<nowiki>-</nowiki>
|
|?
|?
|<nowiki>-</nowiki>
|''[[H. pylori]]''
* Mucosal [[atrophy]]
[[Autoimmune]]
* Mucosal [[atrophy]]
|
* [[Iron deficiency anemia]]
Autoimmune gastritis diagnosis include:
* Antiparietal and anti-IF antibodies
* [[Achlorhydria]] and hypergastrinemia
* Low serum [[vitamin B12|cobalamine]]
|-
![[Crohn's disease]]
|
* [[Autoimmune disease]]
|
* [[Abdominal pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|?
|?
|
* Chronic [[diarrhea]] often bloody with [[pus]] or [[mucus]]
* [[Rectal bleeding]]
|
* Mucosal nodularity with cobblestoning
* Multiple [[aphthous ulcers]]
* Linier or serpiginous ulcerations
* Thickened antral folds
* Antral narrowing
* Hypoperistalsis
* Duodenal strictures
|
* [[Fever]]
* [[Fatigue]]
* [[Anemia]] ([[pernicious anemia]])
|-
![[GERD]]
|
* Lower esophageal sphincter abnormalities
* [[Hiatal hernia]]
* Abnormal esophageal contractions
* Prolonged emptying of [[stomach]]
* [[Gastrinomas]]
|
* [[Epigastric pain]]
|
* Spicy food
* Tight fitting clothing
|
* [[Antacids]]
* Head elevation during sleep
|?
(Suspect delayed gastric emptying)
|?
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Esophagitis]]
* Barrette esophagus
* [[Strictures]]
|Other symptoms:
* [[Dysphagia]]
* [[Regurgitation]]
* [[Cough|Nocturnal cough]]
* [[Hoarseness]]
Complications
* [[Esophagitis]]
* [[Strictures]]
* Barrette esophagus
|-
![[Peptic ulcer disease]]
|
* ''[[H. pylori]]''
* [[Smoking]]
* [[Alcohol]]
* [[Radiation therapy]]
* Medications
* Zollinger-ellison syndrome
|
* [[Epigastric pain]] sometimes extending to back
* [[Right upper quadrant pain]]
|
'''[[Duodenal ulcer]]'''
*Pain aggravates with empty stomach
'''[[Gastric ulcer]]'''
*Pain aggravates with food
|
* [[Antacids]]
* [[Duodenal ulcer]]
:*Pain alleviates with food
|?
|?
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Melena|Black stools]]
|'''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'''
* Well-demarcated break in the [[mucosa]] that may extend into the [[muscularis propria]] of the [[duodenum]]
* Found in the first part of [[duodenum]]
* <1cm
|'''Other diagnostic tests'''
* Serum [[gastrin]] levels
* [[Secretin]] stimulation test
* [[Biopsy]]
|-
![[Gastrinoma]]
|
* Associated with [[MEN type 1]]
|
* [[Abdominal pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|?
(suspect [[gastric outlet obstruction]])
|?
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Melena|Black stools]]
|Useful in collecting the tissue for [[biopsy]]
|
* May present with symptoms of [[GERD]] or [[peptic ulcer disease]]
* Associated with [[MEN type 1]]
'''Diagnostic tests'''
* Serum [[gastrin]] levels
* [[Somatostatin]] receptor [[scintigraphy]]
* [[CT]] and [[MRI]]
|-
![[Gastric Cancer|Gastric Adenocarcinoma]]
|
* ''[[H. pylori]]'' infection
* Smoked and salted food
|
* [[Abdominal pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|?
|?
|?
|?
|?
|
* [[Melena|Black stools]], or blood in stools
|'''Esophagogastroduodenoscopy'''
* Multiple biopsies are taken to establish the diagnosis
|'''Other symptoms'''
* [[Dysphagia]]
* Early [[satiety]]
* Frequent [[burping]]
|-
![[Gastric lymphoma|Primary gastric lymphoma]]
|
* ''[[H. pylori]]'' infection
|
* [[Abdominal pain]]
* [[Chest pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|?
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Useful in collecting the tissue for [[biopsy]]
|'''Other symptoms'''
* Painless swollen [[lymph nodes]] in neck and armpit
* Night sweats
* [[Fatigue]]
* [[Fever]]
* [[Cough]] or trouble breathing
|}
</div>


==References==
==References==

Revision as of 21:21, 27 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Gastritis must be differentiated from peptic ulcer disease, gastric cancer, gastroesophageal reflux disease, gastroenteritis, and Crohn's disease.

Differentiating Gastritis from other Diseases

Differential Diagnosis

Gastritis must be differentiated from:[1][2][3][4][5][6][7][8][9]

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 Epigastric pain - - ? - ? ? - H. pylori

Autoimmune

Autoimmune gastritis diagnosis include:

Crohn's disease - - - - - ? ?
  • Mucosal nodularity with cobblestoning
  • Multiple aphthous ulcers
  • Linier or serpiginous ulcerations
  • Thickened antral folds
  • Antral narrowing
  • Hypoperistalsis
  • Duodenal strictures
GERD
  • Lower esophageal sphincter abnormalities
  • 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.

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