Gastritis [Compatibility Mode]

8/14/2019 Gastritis [Compatibility Mode]

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GastritisGastritis

Prof. Dr. Aliaa Aly El AghouryProf. Dr. Aliaa Aly El Aghoury

Professor of Internal MedicineProfessor of Internal MedicineEndocrinology UnitEndocrinology Unit

Faculty of Medicine, Alex. UniversityFaculty of Medicine, Alex. University

Prof. Dr. Aliaa Aly El AghouryProf. Dr. Aliaa Aly El Aghoury

Professor of Internal MedicineProfessor of Internal MedicineEndocrinology UnitEndocrinology Unit

Faculty of Medicine, Alex. UniversityFaculty of Medicine, Alex. University


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GastritisGastritis

Gastritis is a histologic diagnosis, although itGastritis is a histologic diagnosis, although it

can sometimes be recognized at endoscopy.can sometimes be recognized at endoscopy.

Gastritis is a histologic diagnosis, although itGastritis is a histologic diagnosis, although it

can sometimes be recognized at endoscopy.can sometimes be recognized at endoscopy.


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GastritisGastritis

Acute gastritisAcute gastritisAcute gastritisAcute gastritis

Acute gastritis:Acute gastritis: is often erosive and haemorrhagic.is often erosive and haemorrhagic.Acute gastritis:Acute gastritis: is often erosive and haemorrhagic.is often erosive and haemorrhagic.


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GastritisGastritis

Causes:Causes:Causes:Causes:

Aspirin, NSAIDsAspirin, NSAIDs

H. pylori (initial infection)H. pylori (initial infection)

AlcoholAlcohol

Aspirin, NSAIDsAspirin, NSAIDs

H. pylori (initial infection)H. pylori (initial infection)

AlcoholAlcohol

Severe physiological stressSevere physiological stressBile reflux, e.g. following gastric surgeryBile reflux, e.g. following gastric surgery

Viral infectionsViral infections

Severe physiological stressSevere physiological stressBile reflux, e.g. following gastric surgeryBile reflux, e.g. following gastric surgery

Viral infectionsViral infections


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GastritisGastritis

Acute gastritis often produce no symptoms, butAcute gastritis often produce no symptoms, but

may cause dyspepsia, anorexia, nausea ormay cause dyspepsia, anorexia, nausea or

vomiting and haematemesis or melena.vomiting and haematemesis or melena.

Acute gastritis often produce no symptoms, butAcute gastritis often produce no symptoms, but

may cause dyspepsia, anorexia, nausea ormay cause dyspepsia, anorexia, nausea or

vomiting and haematemesis or melena.vomiting and haematemesis or melena.

Clinical Picture:Clinical Picture:Clinical Picture:Clinical Picture:


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GastritisGastritis

Many cases resolve quickly and do not needMany cases resolve quickly and do not need

investigation.investigation.

Endoscopy & Biospy0 to exclude peptic ulcerEndoscopy & Biospy0 to exclude peptic ulcer

Many cases resolve quickly and do not needMany cases resolve quickly and do not need

investigation.investigation.

Endoscopy & Biospy0 to exclude peptic ulcerEndoscopy & Biospy0 to exclude peptic ulcer

Investigations:Investigations:Investigations:Investigations:

or cancer.or cancer.or cancer.or cancer.


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GastritisGastritis

Treatment of underlying causeTreatment of underlying cause

AntacidsAntacids

Treatment of underlying causeTreatment of underlying cause

AntacidsAntacids

Treatment:Treatment:Treatment:Treatment:

or antiemetics (e.g. metochlopramide).or antiemetics (e.g. metochlopramide).or antiemetics (e.g. metochlopramide).or antiemetics (e.g. metochlopramide).


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GastritisGastritis

Chronic gastritisChronic gastritisChronic gastritisChronic gastritis


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GastritisGastritis

Causes:Causes:Causes:Causes:

Chronic nonChronic non--specific gastritisspecific gastritis

H. pylori infectionH. pylori infection

Autoimmune (pernicious anaemia)Autoimmune (pernicious anaemia)

Chronic nonChronic non--specific gastritisspecific gastritis

H. pylori infectionH. pylori infection

Autoimmune (pernicious anaemia)Autoimmune (pernicious anaemia)

PostPost--gastrectomygastrectomy PostPost--gastrectomygastrectomy


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GastritisGastritis

Most patients are asymptomatic and do notMost patients are asymptomatic and do not

require any treatment.require any treatment.

H. pylori eradication in dyspepsia.H. pylori eradication in dyspepsia.

Most patients are asymptomatic and do notMost patients are asymptomatic and do not

require any treatment.require any treatment.

H. pylori eradication in dyspepsia.H. pylori eradication in dyspepsia.

Treatment:Treatment:Treatment:Treatment:


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GastritisGastritis

Peptic Ulcer diseasePeptic Ulcer diseasePeptic Ulcer diseasePeptic Ulcer disease


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GastritisGastritis

The term peptic ulcer refers to an ulcer in theThe term peptic ulcer refers to an ulcer in the

lower oesophagus, stomach or duodenum.lower oesophagus, stomach or duodenum.Ulcers in the stomach or duodenum may beUlcers in the stomach or duodenum may be

acute or chronic both enetrate the muscularisacute or chronic both enetrate the muscularis

The term peptic ulcer refers to an ulcer in theThe term peptic ulcer refers to an ulcer in the

lower oesophagus, stomach or duodenum.lower oesophagus, stomach or duodenum.Ulcers in the stomach or duodenum may beUlcers in the stomach or duodenum may be

acute or chronic both enetrate the muscularisacute or chronic both enetrate the muscularis

mucosae but the acute ulcer shows no evidencemucosae but the acute ulcer shows no evidenceof fibrosis.of fibrosis.

N.B:N.B:Erosions do not penetrate the muscularis mucosae.Erosions do not penetrate the muscularis mucosae.

mucosae but the acute ulcer shows no evidencemucosae but the acute ulcer shows no evidenceof fibrosis.of fibrosis.

N.B:N.B:Erosions do not penetrate the muscularis mucosae.Erosions do not penetrate the muscularis mucosae.


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GastritisGastritis

Gastric and duodenal ulcerGastric and duodenal ulcerGastric and duodenal ulcerGastric and duodenal ulcer


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GastritisGastritis

The prevalence of peptic ulcer is decreasing asThe prevalence of peptic ulcer is decreasing as

a result of widespread use ofa result of widespread use ofH. pyloriH. pylorieradication therapy.eradication therapy.

Around 90 of duodenal ulcer atients and 70Around 90 of duodenal ulcer atients and 70

The prevalence of peptic ulcer is decreasing asThe prevalence of peptic ulcer is decreasing as

a result of widespread use ofa result of widespread use ofH. pyloriH. pylorieradication therapy.eradication therapy.

Around 90 of duodenal ulcer atients and 70Around 90 of duodenal ulcer atients and 70

of gastric ulcer patients are infected with H.of gastric ulcer patients are infected with H.pylori, the remaining are due to NSAIDs.pylori, the remaining are due to NSAIDs.of gastric ulcer patients are infected with H.of gastric ulcer patients are infected with H.pylori, the remaining are due to NSAIDs.pylori, the remaining are due to NSAIDs.


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GastritisGastritis

1.1. Helicobacter pylori:Helicobacter pylori:

It is gram negative spiral bacteria and has multipleIt is gram negative spiral bacteria and has multiple

flagella at one end which make it motile allowing itflagella at one end which make it motile allowing it

1.1. Helicobacter pylori:Helicobacter pylori:

It is gram negative spiral bacteria and has multipleIt is gram negative spiral bacteria and has multiple

flagella at one end which make it motile allowing itflagella at one end which make it motile allowing it

Aetiology:Aetiology:Aetiology:Aetiology:

to burrow and live deep beneath the mucus layerto burrow and live deep beneath the mucus layerclosely adherent to the epithelial surface.closely adherent to the epithelial surface.to burrow and live deep beneath the mucus layerto burrow and live deep beneath the mucus layerclosely adherent to the epithelial surface.closely adherent to the epithelial surface.


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GastritisGastritis

The bacteria produce the enzyme urease.The bacteria produce the enzyme urease.

Many different diagnostic tests for H. pyloriMany different diagnostic tests for H. pylori

infection are available.infection are available.

The bacteria produce the enzyme urease.The bacteria produce the enzyme urease.

Many different diagnostic tests for H. pyloriMany different diagnostic tests for H. pylori

infection are available.infection are available.

Some are invasive and require endoscope.Some are invasive and require endoscope. Others are non invasive.Others are non invasive.

They vary in sensitivity and specificity.They vary in sensitivity and specificity. Overall breath tests are the best.Overall breath tests are the best.

Some are invasive and require endoscope.Some are invasive and require endoscope. Others are non invasive.Others are non invasive.

They vary in sensitivity and specificity.They vary in sensitivity and specificity. Overall breath tests are the best.Overall breath tests are the best.


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GastritisGastritis

2.2. NSAIDs: by depleting mucosal prostaglandinNSAIDs: by depleting mucosal prostaglandin

causing mucosal injury, erosions andcausing mucosal injury, erosions and

ulceration.ulceration.

2.2. NSAIDs: by depleting mucosal prostaglandinNSAIDs: by depleting mucosal prostaglandin

causing mucosal injury, erosions andcausing mucosal injury, erosions and

ulceration.ulceration.

3.3. SmokingSmoking4.4. AcidAcid--pepsin versus mucosal resistance.pepsin versus mucosal resistance.3.3. SmokingSmoking4.4. AcidAcid--pepsin versus mucosal resistance.pepsin versus mucosal resistance.


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GastritisGastritis

1.1. Recurrent abdominal pain which isRecurrent abdominal pain which is

-- localized to the epigastriumlocalized to the epigastrium

--

1.1. Recurrent abdominal pain which isRecurrent abdominal pain which is

-- localized to the epigastriumlocalized to the epigastrium

--

Clinical Picture:Clinical Picture:Clinical Picture:Clinical Picture:

-- occur in episodesoccur in episodes

2.2. Vomiting in 40% of patients (persistentVomiting in 40% of patients (persistent

vomiting suggests gastric outlet obstruction).vomiting suggests gastric outlet obstruction).

-- occur in episodesoccur in episodes

2.2. Vomiting in 40% of patients (persistentVomiting in 40% of patients (persistent

vomiting suggests gastric outlet obstruction).vomiting suggests gastric outlet obstruction).


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GastritisGastritis

3.3. History of treatment with NSAIDs is sometimesHistory of treatment with NSAIDs is sometimes

present especially in elderly.present especially in elderly.

4.4. Anorexia and nauseaAnorexia and nausea

3.3. History of treatment with NSAIDs is sometimesHistory of treatment with NSAIDs is sometimes

present especially in elderly.present especially in elderly.

4.4. Anorexia and nauseaAnorexia and nausea

5.5. Silent ulcer present with anaemia from chronicSilent ulcer present with anaemia from chronicundetected blood loss.undetected blood loss.

6.6. HaematemesisHaematemesis

5.5. Silent ulcer present with anaemia from chronicSilent ulcer present with anaemia from chronicundetected blood loss.undetected blood loss.

6.6. HaematemesisHaematemesis


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GastritisGastritis

1.1. EndoscopyEndoscopy

2.2. Biopsy if malignant ulcer is suspected.Biopsy if malignant ulcer is suspected.

1.1. EndoscopyEndoscopy

2.2. Biopsy if malignant ulcer is suspected.Biopsy if malignant ulcer is suspected.

Investigation:Investigation:Investigation:Investigation:


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GastritisGastritis

Aims:Aims:

Relieve symptomsRelieve symptoms

Aims:Aims:

Relieve symptomsRelieve symptoms

Management:Management:Management:Management:

Prevent recurrencePrevent recurrence Prevent recurrencePrevent recurrence


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GastritisGastritis

1.1. Proton pump inhibitorProton pump inhibitor

2.2. Plus two antibiotics (From Amoxicillin,Plus two antibiotics (From Amoxicillin,

clarithromycin and metronidazole). For 7 days,clarithromycin and metronidazole). For 7 days,

1.1. Proton pump inhibitorProton pump inhibitor

2.2. Plus two antibiotics (From Amoxicillin,Plus two antibiotics (From Amoxicillin,

clarithromycin and metronidazole). For 7 days,clarithromycin and metronidazole). For 7 days,

1.1. H. pyloriH. pylorieradicationeradication1.1. H. pyloriH. pylorieradicationeradication

success is achieved in >90% of patients.success is achieved in >90% of patients.success is achieved in >90% of patients.success is achieved in >90% of patients.


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GastritisGastritis

Patients who remain infected the choice isPatients who remain infected the choice is

either quadruple therapy (bismuth, protoneither quadruple therapy (bismuth, proton

pump and 2 antibiotics) on long termpump and 2 antibiotics) on long term

Patients who remain infected the choice isPatients who remain infected the choice is

either quadruple therapy (bismuth, protoneither quadruple therapy (bismuth, proton

pump and 2 antibiotics) on long termpump and 2 antibiotics) on long term

ma n enance erapy w ac suppress on.ma n enance erapy w ac suppress on.ma n enance erapy w ac suppress on.ma n enance erapy w ac suppress on.


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GastritisGastritis

Avoid cigarette smoking, Aspirin and NSAIDs.Avoid cigarette smoking, Aspirin and NSAIDs.Avoid cigarette smoking, Aspirin and NSAIDs.Avoid cigarette smoking, Aspirin and NSAIDs.

2. General measures:2. General measures:2. General measures:2. General measures:


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GastritisGastritis

Partial gastrectomy in chronic non healingPartial gastrectomy in chronic non healing

gastric ulcer.gastric ulcer.

Partial gastrectomy in chronic non healingPartial gastrectomy in chronic non healing

gastric ulcer.gastric ulcer.

3. Surgical treatment3. Surgical treatment3. Surgical treatment3. Surgical treatment


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GastritisGastritis

1.1. PerforationPerforation

2.2. Gastric outlet obstructionGastric outlet obstruction

1.1. PerforationPerforation

2.2. Gastric outlet obstructionGastric outlet obstruction

Complications of peptic ulcer diseaseComplications of peptic ulcer diseaseComplications of peptic ulcer diseaseComplications of peptic ulcer disease


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Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023Data show design & preparation by : Dr. El-Sayed Amr - (012) 3106023

Gastritis [Compatibility Mode]

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