Atrophic gastritis: Difference between revisions
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===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
==Differential diagnosis== | |||
==Differential Diagnosis== | |||
Atrophic 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> | |||
==Treatment== | ==Treatment== |
Latest revision as of 21:23, 27 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Atrophic gastritis is a process of chronic inflammation of the stomach mucosa, leading to loss of gastric glandular cells and their eventual replacement by intestinal and fibrous tissues. As a result, the stomach's secretion of essential substances such as hydrochloric acid, pepsin, and intrinsic factor is impaired, leading to digestive problems, vitamin B12 deficiency, and megaloblastic anemia. It can be caused by persistent infection with Helicobacter pylori, or can be autoimmune in origin.
Autoimmune Metaplastic Atrophic Gastritis (AMAG) is an inherited form of atrophic gastritis characterized by an immune response directed toward parietal cells and intrinsic factor. The presence of serum antibodies to parietal cells and to intrinsic factor are characteristic findings. The autoimmune response subsequently leads to the destruction of parietal cell mass which then results in profound hypochlorhydria (and elevated gastrin levels). The inadequate production of intrinsic factor also leads to vitamin B12 malabsorption and pernicious anemia. AMAG is typically confined to the gastric body and fundus
Hypochlorhydria induces G Cell (Gastrin producing) hyperplasia which leads to hypergastrinemia. Gastrin exerts a trophic effect on enterochromaffin-like cells (ECL cells are responsible for histamine secretion) and is hypothesized to be one mechanism to explain the malignant transformation of ECL cells into carcinoid tumors in AMAG.
Patients with AMAG and pernicious anemia are also at increased risk for the development of gastric adenocarcinoma. The optimal endoscopic surveillance strategy is not known but all nodules and polyps should be removed in these patients.
Environmental metaplastic atrophic gastritis (EMAG) is due to environmental factors, such as diet and H. pylori infection. EMAG is typically confined to the body of the stomach. Patients with EMAG are also at increased risk of gastric carcinoma.
Recent research has shown that AMAG is a result of the immune system attacking the parietal cells,the attack is being triggered by H. pylori through a mechanism called molecular mimicry.
Historical Perspective
Classification
Pathophysiology
Causes
Drug Side Effect
Differentiating Atrophic gastritis from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Differential diagnosis
Differential Diagnosis
Atrophic 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
|
- | |
Atrophic gastritis | Epigastric pain | - | - | ? | - | ? | ? | - | H. pylori
|
Autoimmune gastritis diagnosis include:
| ||
Crohn's disease | - | - | - | - | - | ? | ? |
|
|
|||
GERD |
|
|
|
?
(Suspect delayed gastric emptying) |
? | - | - | - | - |
|
Other symptoms:
Complications
| |
Peptic ulcer disease |
|
|
Duodenal ulcer
|
|
? | ? | - | - | - | Gastric ulcers
Duodenal ulcers
|
Other diagnostic tests | |
Gastrinoma |
|
- | - | ?
(suspect gastric outlet obstruction) |
? | - | - | - | Useful in collecting the tissue for biopsy |
Diagnostic tests
| ||
Gastric Adenocarcinoma |
|
- | - | ? | ? | ? | ? | ? |
|
Esophagogastroduodenoscopy
|
Other symptoms | |
Primary gastric lymphoma |
|
- | - | - | - | - | ? | - | - | Useful in collecting the tissue for biopsy | Other symptoms
|
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ 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.
- ↑ Sipponen P, Maaroos HI (2015). "Chronic gastritis". Scand J Gastroenterol. 50 (6): 657–67. doi:10.3109/00365521.2015.1019918. PMC 4673514. PMID 25901896.
- ↑ 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.
- ↑ Sipponen P (1989). "Atrophic gastritis as a premalignant condition". Ann Med. 21 (4): 287–90. PMID 2789799.
- ↑ 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.
- ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
- ↑ 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.
- ↑ 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.
- ↑ 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.