Gastritis - Clinicals, Diagnosis, and Management

Upper GI

Clinicals - History

Fact Explanation
Abdominal pain - Upper abdomen/ epigastric Inflammation with associated mucosal injury Abdominal pain - Upper abdomen/ epigastric
Inflammation with associated mucosal injury
Anorexia Inflammation of the stomach Anorexia
Inflammation of the stomach
Nausea Inflammation of the stomach Nausea
Inflammation of the stomach
Vomitting Inflammation of the stomach Vomitting
Inflammation of the stomach
Hematemesis - Coffee ground colour Inflammation with associated mucosal injury causing bleeding Hematemesis - Coffee ground colour
Inflammation with associated mucosal injury causing bleeding
Melena Inflammation with associated mucosal injury causing bleeding Melena
Inflammation with associated mucosal injury causing bleeding
Symptoms of Anemia Due to Chronic blood loss or Due to anemia Resulting from Pernicious Anemia of Atrophic Gastritis Symptoms of Anemia
Due to Chronic blood loss or Due to anemia Resulting from Pernicious Anemia of Atrophic Gastritis
Neurological symptoms - Peripheral symptoms such as numbness, disturbance of gait, ataxia Atrophic gastritis may cause Vitamin B12 deficiency Neurological symptoms - Peripheral symptoms such as numbness, disturbance of gait, ataxia
Atrophic gastritis may cause Vitamin B12 deficiency
Past medical histroy of NSAID use, steroid use Both NSAIDs and Corticosteroids reduce Prostaglandin production thereby reducing production of Gastric Mucus Past medical histroy of NSAID use, steroid use
Both NSAIDs and Corticosteroids reduce Prostaglandin production thereby reducing production of Gastric Mucus

Clinicals - Examination

Fact Explanation
Epigastric tenderness Inflammation of the stomach Epigastric tenderness
Inflammation of the stomach
Tachycardia Dehydration following vomiting Tachycardia
Dehydration following vomiting
Pallor Usually due to long standing blood loss from stomach Pallor
Usually due to long standing blood loss from stomach
Board like rigidity and severe tenderness of abdomen Perforated peptic ulcer Board like rigidity and severe tenderness of abdomen
Perforated peptic ulcer
Succussion splash of stomach Gastric outlet obstruction due to peptic ulcer disease Succussion splash of stomach
Gastric outlet obstruction due to peptic ulcer disease
Pallor with mild jaundice, tachycardia, cardiomegaly and cardiac flow murmur on ausculation Severe Vitamin B12 deficiency of atrophic gastritis Pallor with mild jaundice, tachycardia, cardiomegaly and cardiac flow murmur on ausculation
Severe Vitamin B12 deficiency of atrophic gastritis
Neurological signs - Ataxic gait Severe Vitamin B12 deficiency of atrophic gastritis Neurological signs - Ataxic gait
Severe Vitamin B12 deficiency of atrophic gastritis

Investigations - Diagnosis

Fact Explanation
Upper GI endoscopy Ability to directly visualize the gastric mucosa, and take biopsies to exclude malignant lesions. or detect Atrophic Gastritis. Upper GI endoscopy
Ability to directly visualize the gastric mucosa, and take biopsies to exclude malignant lesions. or detect Atrophic Gastritis.
Barium studies To detect peptic or duodenal ulcers Barium studies
To detect peptic or duodenal ulcers
Non-endoscopic investigation for helicobacter pylori: IgG antibodies for H. pylori, Urea breath test, H. pylori antigen in stool Helicobacter pylori infection commonly causes gastritis, peptic ulcer disease, duodenal ulcer disease Non-endoscopic investigation for helicobacter pylori: IgG antibodies for H. pylori, Urea breath test, H. pylori antigen in stool
Helicobacter pylori infection commonly causes gastritis, peptic ulcer disease, duodenal ulcer disease
Endoscopic investigation for helicobacter pylori: Biopsy urease test, biopsy for histology, biopsy for culture of H. pylori Helicobacter pylori infection commonly causes gastritis, peptic ulcer disease, duodenal ulcer disease Endoscopic investigation for helicobacter pylori: Biopsy urease test, biopsy for histology, biopsy for culture of H. pylori
Helicobacter pylori infection commonly causes gastritis, peptic ulcer disease, duodenal ulcer disease
Serum Gastrin level To diagnose Zollinger-Ellison syndrome Serum Gastrin level
To diagnose Zollinger-Ellison syndrome

Investigations - Management

Fact Explanation
Repeat testing for H. pylori after course of anti-H. pylori treatment - Urea breath test or H pylori stool antigen test if ulcer was duodenal, endoscopy if it was gastric. To ensure H. pylori eradication and healing of gastric ulcer if present. Repeat testing for H. pylori after course of anti-H. pylori treatment - Urea breath test or H pylori stool antigen test if ulcer was duodenal, endoscopy if it was gastric.
To ensure H. pylori eradication and healing of gastric ulcer if present.
Repeat annual upper GI endoscopy for patients with atrophic gastritis who have intestinal metaplasia on histology To screen for malignant change. Repeat annual upper GI endoscopy for patients with atrophic gastritis who have intestinal metaplasia on histology
To screen for malignant change.
Hemoglobin level Anemia due to chronic blood loss or anemia due to Atrophic gastritis causing Pernicious anemia Hemoglobin level
Anemia due to chronic blood loss or anemia due to Atrophic gastritis causing Pernicious anemia
Blood picture - Megaloblastic anemia with hyper segmented neutrophils. Due to atrophic gastritis causing pernicious anemia Blood picture - Megaloblastic anemia with hyper segmented neutrophils.
Due to atrophic gastritis causing pernicious anemia
Antibodies against Intrinsic factor and gastric parietal cell To screen for atrophic gastritis and pernicious anemia Antibodies against Intrinsic factor and gastric parietal cell
To screen for atrophic gastritis and pernicious anemia

Management - Supportive

Fact Explanation
Proton-pump inhibitors eg; Omeprazole, Pantaprazole, Lanzaprozole Reduces gastric acid secretion Proton-pump inhibitors eg; Omeprazole, Pantaprazole, Lanzaprozole
Reduces gastric acid secretion
H2 Blockers eg; Cimetidine, Famotidine, Ranitidine, etc Reduces gastric acid secretion. H2 Blockers eg; Cimetidine, Famotidine, Ranitidine, etc
Reduces gastric acid secretion.
Antacids Symptomatic; Neutralizes gastric acid Antacids
Symptomatic; Neutralizes gastric acid
Prokinetic drugs eg; Domperidone, Metochlopramide Increases evacuation of gastric acid from the stomach Prokinetic drugs eg; Domperidone, Metochlopramide
Increases evacuation of gastric acid from the stomach
Parenteral Vitamin B12 supplementation in Atrophic gastritis Reduced production of intrinsic factor due to depleted parietal cells in atrophic gastritis. Therefore reduced absorption of Vitamin B12 from intestine. Parenteral Vitamin B12 supplementation in Atrophic gastritis
Reduced production of intrinsic factor due to depleted parietal cells in atrophic gastritis. Therefore reduced absorption of Vitamin B12 from intestine.

Management - Specific

Fact Explanation
Eradication of H. pylori Triple therapy regimes, e.g. Omeprazole 20mg + Clarithromycin 500mg + Amoxicillin 1g all twice daily for 14 days or Omeprazole 20mg + Clarithromycin 500mg + Metronidazole 500mg all twice daily for 14 days If peptic ulcer disease is present Eradication of H. pylori Triple therapy regimes, e.g. Omeprazole 20mg + Clarithromycin 500mg + Amoxicillin 1g all twice daily for 14 days or Omeprazole 20mg + Clarithromycin 500mg + Metronidazole 500mg all twice daily for 14 days
If peptic ulcer disease is present

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