Gastritis: Clinical sciences

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Gastritis, or inflammation of the gastric mucosa, is typically associated with excessive acid production, which can eventually lead to erosions and ulcerations of the stomach lining, destruction of the glandular layer of the stomach, and fibrosis. Based on the duration of symptoms, gastritis can be classified as acute, persistent, and chronic. Acute and persistent gastritis last less than 30 days and include stress-, chemical-, and infectious gastritis. On the other hand, chronic gastritis persists for more than 30 days and includes autoimmune-, H. Pylori, and reactive gastritis.
Now, if a patient presents with chief concerns suggesting gastritis, first obtain a focused history and physical exam as well as labs, including CBC and fecal occult blood test. These patients will report upper abdominal pain, indigestion, and, in some cases, symptoms like nausea, vomiting, and bloating. The physical exam may reveal epigastric tenderness and halitosis, as well as signs of pallor and tachycardia. Moreover, pallor and tachycardia are signs of anemia, which occurs when inflammation of gastric mucosa results in mucosal erosions, ulcers, and subsequent bleeding. So, keep in mind that, in some individuals, labs might reveal anemia or a positive fecal occult blood test. If your patient presents with these findings, suspect gastritis and assess the duration of symptoms.
Symptoms that last 30 days or less are suggestive of acute- or persistent gastritis. Moreover, symptoms of acute gastritis last 14 days or less, while symptoms of persistent gastritis last from 15 to 30 days. Both types are associated with the same conditions, so your next step is to assess the underlying cause. First, review the patient’s history and physical exam findings and be sure to order esophagogastroduodenoscopy or EGD for short, to visualize gastric mucosa, and if needed, take biopsy samples. Additionally, if you suspect infectious gastritis, don’t forget to order relevant microbiology testing for bacteria, viruses, fungi, and parasites associated with gastritis.
First let’s discuss stress gastritis! In this case, the patient will report a stressful physiological event, such as trauma, shock, sepsis, or surgery, while the EGD will reveal superficial erythematous mucosal erosions. With these findings, diagnose stress gastritis and proceed with treatment, which includes medications for acid suppression, such as proton pump inhibitors or H2 blockers. Keep in mind that you should also use these medications as prophylaxis in critically ill patients to prevent stress gastritis and potentially life-threatening complications, like gastric hemorrhage, perforation, and sepsis.
Sources
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