Gastritis overview
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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 is inflammation of the gastric mucosa. The word comes from the Greek gastro- meaning of the stomach and -itis meaning inflammation. Depending on the cause, it may persist acutely or chronically and may coincide with more serious conditions such as atrophy of the stomach.
Historical Perspective
n 1728, a German physician named Georg Ernst Stahl first used the term "gastritis" to describe inflammation of the inner lining of the stomach. In 1982, Robin Warren and Barry Marshall discovered Helicobacter pylori which further led to the identification and classification of different gastritides. in 1990, A New Classification of Gastritis called the Sydney System was presented to the World Congress of Gastroenterology in Sydney and was later published as six papers in the Journal of Gastroenterology and Hepatology. In 1994, at the International Workshop on the Histopathology of Gastritis held at Houston, The updated Sydney System for the classification and grading of gastritis was introduced. In 2005, Gastritis staging using the OLGA (Operative Link on Gastritis Assessment) staging system for reporting gastric histology was introduced.
Classification
Classification and grading of Gastritis based on the Updated Sydney System emphasizes the importance of combining topographical, morphological, and etiological information into a schema that would help to generate reproducible and clinically useful diagnoses. In clinical practice, Gastritis staging is done using the OLGA (Operative Link on Gastritis Assessment) staging system for reporting gastric histology. Gastritis staging integrates the atrophy score (obtained by biopsy) and the atrophy topography (achieved through directed biopsy mapping).
Pathophysiology
Gastritis depending on the causes may be classified into acute gastritis, chronic gastritis, atrophic gastritis, and H.pylori associated gastritis. In acute gastritis, the majority of patients, the initial acute phase of gastritis is subclinical and is of short duration (about 7 to 10 days). Acute gastritis also referred to as reactive gastritis occurs as a result of the trigger by factors such as NSAIDs, stress, bile reflux, radiation, alcohol abuse, cocaine addiction and ischemic damage. In chronic gastritis, the H. pylori infection persists leading to accumulation of large number chronic inflammatory cells leading to active chronic gastritis.
Causes
The most common causes of Gastritis include H. pylori infection, alcohol consumption, cigarette smoking, extended use of NSAIDs and autoimmune gastritis. Less common causes of Gastritis include cocaine addiction, bile reflux, and Crohn's disease.
Differentiating Gastritis overview from Other Diseases
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.
Epidemiology and Demographics
In acute gastritis, the prevalence of eosinophilic gastritis is approximately 6.3 per 100,000 individuals worldwide. The incidence of new cases of H.pylori infection each year ranges from 3,000 to 10,000 per 100,000 individuals in developing countries. It has been observed that with advancing age, the incidence of H.pylori infection is increased. In united states, 20% of adolescents are infected with H. pylori when compared to 90% in by 5 years of age in developing countries. In United States, H. pylori infection associated gastritis is more common in African Americans (54%), Hispanics (52%), and the elderly compared to Whites(21%). In Acute Gastritis, females are usually more affected than men. In H. pylori infection associated gastritis, males are more commonly affected than females. The incidence rates of H.pylori infection are high in Japan, Columbia, Costa Rica and China, and comparatively low in the United States. H.pylori infection is common in southern and eastern Europe, Mexico, South America, Africa, most Asian countries, and aboriginal people in North America.
Risk Factors
Common risk factors in the development of Gastritis include alcohol, NSAIDs, cocaine, autoimmune gastritis, crohn’s disease, HIV/AIDS and bacterial infections such as Helicobacter pylori.
Screening
There is insufficient evidence to recommend routine screening for gastritis.
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Symptoms of gastritis may be silent or manifest as abdominal discomfort, nausea, vomiting, and/or gastrointestinal bleeding.
Physical Examination
Patients with Gastritis may appear pale. Some patients may appear fatigued and in distress if associated with abdominal pain. Vital signs generally appear to be normal. If associated with GI bleed, Vital signs include tachycardia. Pallor may observed in patients presenting with melena and hematemesis. On examination of the eyes, conjunctival pallor may be observed. Halitosis may be observed in case of Chronic Gastritis. Chest tenderness may be present on palpation in case of Helicobacter pylori infection associated Gastritis. Abdominal pain or discomfort may be observed. Epigastric tenderness may be present. Gastritis associated with gastric ulcers may result in blood loss and the stool test may be guaiac-positive.