Question

    Acute Gastritis

    Gastritis helicobacter - intermed mag[1]

    Acute gastritis is an inflammation of the stomach lining, which may develop due to the use of certain drugs or other underlying causes that result in abdominal pain and discomfort.

    Presentation

    The most common symptoms of gastritis are pain or upper abdominal discomfort [9]. Some patients, especially elderly people, may present no symptoms at all until they start to suffer from bleeding [10]. The pain caused by gastritis is usually described as soreness or burning located in the upper central part of the abdomen; however, it might be felt in the left upper part of the abdomen or in the back. Abdominal discomfort may also be present in patients with gastritis. Other symptoms that may develop in patients with acute gastritis include belching, fullness, bloating, nausea and vomiting. Depending on the severity of the inflammation, the vomit may be clear, yellow or green, and may contain blood. The severity of the symptoms does not always correlate to the actual physical changes in the stomach lining. Some patients may suffer from severe symptoms even though the lining of the stomach shows only minor changes. Others may not experience any symptoms, while endoscopy shows evidence of gastritis.

    Entire body system
    Chills
    • Fever, chills, and hiccups also may be present.[youtube.com]
    • The main symptoms of phlegmonous (purulent) gastritis are: Frequent vomiting; Pus in the vomit; Fever and chills; Severe pain.[en.medicine-worlds.com]
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  • gastrointestinal
    Abdominal Pain
    • Occasionally, acute abdominal pain can be a presenting symptom.[youtube.com]
    • Acute gastritis is sudden inflammation of the stomach lining resulting in abdominal pain, bleeding, or other gastrointestinal symptoms.[healthgrades.com]
    • When symptoms develop they include burning upper abdominal pain and discomfort. [symptoma.com]
    • There may be no symptoms but, when symptoms are present, the most common is upper abdominal pain.[en.wikipedia.org]
    • Acute gastritis almost always involves intense abdominal pain.[petwave.com]
    Acute Abdomen
    • This includes signs of an acute abdomen, which may require surgical intervention Chemically-induced gastroenteritis, e.g., from alcohol, other drugs of abuse or other irritant chemicals Use within 24 hours of study entry of specific medication for treatment[clinicaltrials.gov]
    • AJR Am J Roentgenol 173:357–361 PubMed Google Scholar Gore RM, Miller FH, Pereles FS, Yaghmai VY, Berlin JW (2000) Helical CT in the evaluation of acute abdomen.[link.springer.com]
    Dyspepsia
    • Very mild dyspepsia also occurs with acute stress gastritis.[merckmanuals.com]
    • Up to 25% of the United State's population are reported to suffer from dyspeptic symptoms. 50% of patients who undergo upper endoscopy are diagnosed with gastritis or other non-ulcer dyspepsia.[symptoma.com]
    • Putrid variety of dyspepsia.[treatment.hpathy.com]
    • Acute gastritis may produce no symptoms but can be associated with short-lived dyspepsia, lack of appetite, nausea or vomiting.[gastrointestinalatlas.com]
    • Gastritis (also called dyspepsia) is an inflammation (swelling and irritation) of the lining of the stomach.[my.clevelandclinic.org]
    Early Satiety
    • satiety Loss of appetite Unexplained weight loss Common causes include Helicobacter pylori and NSAIDs.[en.wikipedia.org]
    Epigastric Pain
    • Depends on the aetiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Aetiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDS autoimmune caustic ingestion[radiopaedia.org]
    • Acute Gastritis is frequently subclinical but may manifest with epigastric pain, nausea, or vomiting.[pathwaymedicine.org]
    • Seek prompt medical care if you have symptoms of acute gastritis, such as indigestion, pain in the upper area of your abdomen (epigastric pain), nausea, vomiting, or loss of appetite, or if you are being treated for acute gastritis but mild symptoms recur[healthgrades.com]
    • Symptoms include anorexia, nausea, epigastric pain, vomiting, thirst, and, when patients become dehydrated, prostration.[medical-dictionary.thefreedictionary.com]
    • Disease Topics Related To Acute Gastritis Research the causes of these diseases that are similar to, or related to, Acute Gastritis: NSAIDs Spicy food Smoking Heartburn Epigastric pain Helicobacter pylori infection Proton pump inhibitors more related[rightdiagnosis.com]
    Gastropathy
    • Gastrointestinal Disorders GASTRITIS & GASTROPATHY Current Medical Diagnosis & Treatment 2018 ...[accessmedicine.mhmedical.com]
    • (See "Classification and diagnosis of gastritis and gastropathy" .)[uptodate.com]
    • Epithelial cell damage and regeneration without associated inflammation is properly referred to as "gastropathy".[gastrointestinalatlas.com]
    • Classification and diagnosis of gastritis and gastropathy. http://www.uptodate.com/home.[mayoclinic.org]
    • Reactive gastropathy is the second most common diagnosis made on gastric biopsy specimens after H pylori gastritis.[emedicine.medscape.com]
    Hematemesis
    • Signs of mild to massive upper GI bleeding, including melena or 'coffee ground' hematemesis, may also arise.[pathwaymedicine.org]
    • […] mechanical trauma (nasogastric tube), distal gastrectomy Symptoms: none; or pain, nausea and vomiting May be accompanied by local hemorrhage or mucosal sloughing Severe erosive disease may cause acute GI bleed, acute gastric ulcer Major cause of massive hematemesis[pathologyoutlines.com]
    • It can occasionally be severe enough to cause gastrointestinal bleeding with melena or hematemesis.[gastrointestinalatlas.com]
    • Symptoms of Gastritis Abdominal discomfort or pain under the rib cage Nausea, occasionally with vomiting, that may last 24 to 48 hours Distress that may appear as fatigue or restlessness Grimacing Loss of appetite Swollen abdomen Cramping Vomiting blood or hematemesis[healthcommunities.com]
    • Weight loss, vomiting, diarrhea, hematemesis and hypoalbuminemia occur.[medical-dictionary.thefreedictionary.com]
    Hiccup
    • Fever, chills, and hiccups also may be present.[youtube.com]
    • However, the most common symptoms include: Nausea or recurrent upset stomach Abdominal bloating Abdominal pain Vomiting Indigestion Burning or gnawing feeling in the stomach between meals or at night Hiccups Loss of appetite Vomiting blood or coffee ground-like[webmd.com]
    • Acute gastritis is marked by the sudden onset of stomach pain, nausea, indigestion, heartburn, hiccups, decreased or absent appetite, passing dark stool and possibly vomiting.[livestrong.com]
    • […] gnawing sensation in the stomach between meals or at night Recurrent indigestion, nausea or stomach upset Abdominal bloating or distension Loss of appetite or difficulty eating Vomiting black or coffee-ground like material Passing black or tarry stools Hiccups[bloatingtips.co.uk]
    Loss of Appetite
    • In addition it has the following allied symptoms: Loss of appetite Chronic blenching and bloating Nausea and vomiting Loss of weight due to loss of appetite and nausea Headache, Weakness and dizziness Foul breath, bad taste in mouth.[home-cure.net]
    • Other possible symptoms include nausea and vomiting, bloating, loss of appetite and heartburn.[en.wikipedia.org]
    • Depends on the aetiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Aetiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDS autoimmune caustic ingestion[radiopaedia.org]
    • Chronic gastritis, which is fairly common among the elderly, can occur over a long period and may produce similar symptoms or only mild discomfort, along with loss of appetite and nausea.[healthcommunities.com]
    • Other symptoms include nausea, vomiting, loss of appetite, belching, and bloating.[youtube.com]
    Melena
    • Signs of mild to massive upper GI bleeding, including melena or 'coffee ground' hematemesis, may also arise.[pathwaymedicine.org]
    • It can occasionally be severe enough to cause gastrointestinal bleeding with melena or hematemesis.[gastrointestinalatlas.com]
    • The signs and symptoms of Acute Gastritis include: Dark stools (melena) Abdominal pain Feeling of distention, abdominal bloating Burning feeling in the stomach in between meals Hiccups Nausea, vomiting, and indigestion Loss of appetite Vomiting blood[dovemed.com]
    • If bleeding is mild and slow, people may have no symptoms or may notice only black stool (melena), caused by the black color of digested blood.[merckmanuals.com]
    Nausea
    • Other symptoms include nausea, vomiting, loss of appetite, belching, and bloating.[youtube.com]
    • In addition it has the following allied symptoms: Loss of appetite Chronic blenching and bloating Nausea and vomiting Loss of weight due to loss of appetite and nausea Headache, Weakness and dizziness Foul breath, bad taste in mouth.[home-cure.net]
    • Chronic gastritis, which is fairly common among the elderly, can occur over a long period and may produce similar symptoms or only mild discomfort, along with loss of appetite and nausea.[healthcommunities.com]
    • Antiemetics and analgesics may be provided before meals to manage associated nausea and pain.[medical-dictionary.thefreedictionary.com]
    • Some people with gastritis have no symptoms at all, while others may have burning abdominal pain, nausea, vomiting, dark-colored stools, or appetite loss.[healthgrades.com]
    Severe Abdominal Pain
    • This is the case in phlegmonous gastritis (gangrene of the stomach) where severe abdominal pain accompanied by nausea and vomiting of potentially purulent gastric contents can be the presenting symptoms.[youtube.com]
    • Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms of acute gastritis such as severe abdominal pain; sudden onset of bloody or black, tarry stools; or vomiting bloody or black material.[healthgrades.com]
    • It often causes severe abdominal pain that subsides within a few days.[emedicine.medscape.com]
    • Affected animals suffer severe abdominal pain and intermittent bouts of vomiting.[petwave.com]
    Vomiting
    • The main symptom is severe vomiting.[insideoutdogtraining.com]
    • When vomiting, a patient can become dehydrated and lose electrolytes.[jbu.edu]
    • The most common clinical signs associated with gastritis are acute vomiting and decreased appetite (anorexia).[vcahospitals.com]
    • Dexamethasone did not lower the risk of further vomiting or hospital admission compared with placebo and was less effective than ondansetron in relieving vomiting.[archpedi.jamanetwork.com]
    • A vomiting episode is defined as an episode of forceful expulsion of stomach contents.[clinicaltrials.gov]
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  • cardiovascular
    Heart Failure
    • Congestive heart failure, bradyarrhythmia (baseline pulse 55/min), known long QT syndrome Patient who have known QTc prolongation 450 msec, noted on prior or screening ECG, or who are taking medication known to cause QT prolongation.[clinicaltrials.gov]
    • Vomiting alone can be the first symptom of metabolic disorders, congestive heart failure, toxic agent ingestion, or trauma.[cdc.gov]
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  • Workup

    Complete history about the symptoms and risk factors of developing gastritis is important in reaching the diagnosis. Several tests can be ordered to verify the diagnosis including routine complete blood count to check for general health; fecal test to look for blood in stool [11]; and checking for the presence of Helicobacter pylori bacteria by testing saliva, blood, or breath. Upper endoscopy of the esophagus and the stomach may be conducted to examine the lining of the stomach [12]. A biopsy may be taken and examined to rule out other causes [13]. Imaging studies with X-rays may be required to exclude structural problems.

    Laboratory

    Stool
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  • Treatment

    Patients who take aspirin or other nonsteroidal anti-inflammatory drugs regularly are found to have a higher risk of developing dyspepsia and gastritis, which necessitates the discontinuation of these drugs in order to reduce the associated gastrointestinal conditions [14] [15]. Treatment of gastritis caused by Helicobacter pylori bacterial infection includes three drugs, levofloxacin, amoxicillin, and a proton pump inhibitor (PPI). In some patients this combination may not be effective as a treatment, in these cases the former two drugs are replaced with bismuth and tetracycline along with metronidazole and the PPI [14]. It is thought that Helicobacter pylroi treatment may deteriorate gastroesophageal reflux disease (GERD); however, there is no evidence of that. It is recommended to use the PPI pantoprazole in patients who also take clopidogrel, as it appears to cause only minimal interaction regarding antiplatelet activity. Patients suffering from vomiting require the administration of fluids and electrolytes. Medical treatment is usually sufficient in managing gastritis. Although, in the case of stomach gangrene (phlegmonous gastritis), surgical intervention may be required to remove the affected area of the stomach.

    Prognosis

    Gastritis responds well to treatment and has good prognosis; however, symptoms may flare up in some patients depending on the factors affecting the lining of the stomach [1]. Some patients may suffer from internal bleeding or severe symptoms, which requires further workup in order to rule out more serious conditions.

    Complications

    Acute Pancreatitis
    • Summary of the international symposium on acute pancreatitis.[bmcinfectdis.biomedcentral.com]
    • Ann Pathol 27:439–447 PubMed CrossRef Google Scholar Chen TA, Lo GH, Lin CK, Lai KH, Wung HY, Yu HC, Hsu PI, Chen HH, Tsai WL, Chen WC (2007) Acute pancreatitis associated acute gastro-intestinal mucosal lesions: incidence, characteristic and clinical[link.springer.com]
    Food Poisoning
    • It is commonly called food poisoning.[nlm.nih.gov]
    • Gastritis is one of the most common stomach disorders, and occurs in acute, chronic, and toxic forms. acute gastritis severe gastritis that may be caused by intake of aspirin or other nonsteroidal antiinflammatory drugs , food poisoning , overeating,[medical-dictionary.thefreedictionary.com]
    • Most acute cases of gastritis in cats are caused by food poisoning, overeating or bacterial or viral infections.[petwave.com]
    • The reason is that antibiotics kill off not only "bad"... read more » Food poisoning may actually be an infectious disease : Many people who come down with "stomach symptoms" like diarrhea assume that it's "something I ate" (i.e. food poisoning ).[rightdiagnosis.com]
    • Acute gastritis may be caused by excessive intake of alcohol, ingestion of irritating drugs, food poisoning , and infectious diseases.[britannica.com]
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  • Etiology

    The lining of the stomach may be damaged or weak, which allows irritation by digestive acids. This results in acute gastritis. The causes listed by the National Institutes of Health for the developing of this condition include bacterial infections (especially Helicobacter pylori) [2], exaggerated alcohol consumption, and medications such as corticosteriods and nonsteroidal anti-inflammatory drugs (NSAIDs) [3]. Other risk factors include extreme stress, bile reflux, cocaine use, poison ingestion, kidney failure, surgery, Crohn disease and other digestive diseases, viral infections, and autoimmune disorders resulting in the attack of the stomach lining by the immune system.

    Epidemiology

    There are not sufficient statistical data about gastritis. 10% to 20% of patients taking nonsteroidal anti-inflammatory drugs are reported to suffer from dyspeptic symptoms; however, the prevalence may range from 5% to 50% [4]. Up to 25% of the United State's population are reported to suffer from dyspeptic symptoms. 50% of patients who undergo upper endoscopy are diagnosed with gastritis or other non-ulcer dyspepsia [5]. Several factors may affect the development of acute gastritis due to a bacterial infection with Helicobacter pylori in developing countries. These comprise environmental factors, geography, age, socio-economic status, and strain virulence [6]. Acute gastritis due to autoimmune diseases is more prevalent among people from Scandinavian ancestry or North Europeans.

    Sex distribution
    Age distribution

    Pathophysiology

    Gastric mucosal blood flow is decreased due to nonsteroidal anti-inflammatory drugs and alcohol consumption resulting in the loss of the mucosal protective barrier. Sulfhydryl compounds in gastric mucosa are depleted by alcohol consumption, whereas prostaglandin production is inhibited by NSAIDs [7]. A severe inflammatory response with increased mucosal permeability and degradation of gastric mucin is induced by Helicobacter pylori bacterial infection. The gastric epithelium is affected by its cytotoxicity [2]. Bacteria do not grow normally in the stomach because of the low gastric fluid pH. However, ingested bacteria may become more invasive in the case of damaged gastric mucosa due to ingestion of foreign bodies, ulcer, or carcinoma [8]. An autoimmune chronic inflammation may be stimulated by anti-parietal cell antibodies, resulting in lymphocytic infiltrate and leading to parietal and chief cells loss.

    Prevention

    Prevention of gastritis is achieved by avoiding the underlying cause, like excessive alcohol consumption, toxins ingestion, or the use of NSAIDs [16]. Gastritis due to bacterial infections can be evaded by maintaining a good hygiene, hand washing, and ensuring the food and water are clean.

    Summary

    Acute gastritis is an inflammatory process in the gastrointestinal system. It may affect the whole stomach or part of it and can be divided into two main categories: erosive and nonerosive gastritis [1]. The most common cause of gastritis is the use of nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen; however, there are different etiologic factors including excessive alcohol consumption, autoimmune diseases, and bacterial infection with Helicobacter pylori. Most patients with gastritis appear to be asymptomatic [2]. When symptoms develop they include burning upper abdominal pain and discomfort. Patients may also suffer from nausea and vomiting. Laboratory studies include blood and fecal tests to check the general status of health and to look for blood in the stool. Upper gastroesophageal endoscopy and biopsy sample may be done in order to rule out other conditions. Many patients do not suffer from any symptoms and are diagnosed incidentally when they undergo endoscopy for other reasons. Other breath tests may be performed to confirm the presence of Helicobacter pylori bacteria.

    Gastritis is easily managed and the treatment depends on the causing factor. In case of nonsteroidal anti-inflammatory drugs (NSAIDs), it is advised to discontinue these drugs as they irritate the stomach. Alcoholic patients are encouraged to stop drinking. Patients who are diagnosed with Helicobacter pylori infection will need drug treatment, which initially includes three drugs; a proton pump inhibitor, levofloxacin, and amoxillin. If there is no improvement, the latter two drugs are replaced with bismuth and tetracylin and metronidazole is added to the treatment. Surgical intervention is usually not necessary, except in cases of stomach gangrene. Gastritis scarcely leads to complications and patients usually respond to treatment with good prognosis; however, in rare cases, severe symptoms or bleeding may occur. Avoiding the overuse of NSAIDs and alcohol consumption will decrease the risk of developing gastritis. Maintaining a good hygiene will also help in the prevention of gastritis due to bacterial infections.

    Patient Information

    Acute gastritis is an inflammation of the stomach resulting in abdominal pain and discomfort, which is caused by different underlying factors.

    Causes

    Several causes are associated to the developing of acute gastritis including certain drugs such as aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs; excessive alcohol consumption; toxins ingestion; severe stress; direct trauma; bacterial infections (especially Helicobacter pylori bacteria); viral and fungal infection.

    Presentation

    Patients suffering from gastritis usually present with burning pain in the upper abdomen, which may also be felt in the back. Eating may exacerbate the pain or relieve it. Other symptoms include nausea and vomiting. Most patients have a history of nonsteroidal anti-inflammatory drug use or the exposure to toxin chemicals. Many patients do not present symptoms at all. They are usually diagnosed by accident while undergoing an endoscopy for other purposes. Elderly people have a higher likelihood of developing painless gastritis. The severity of the symptoms does not necessarily correspond to the actual changes seen in the stomach by endoscopy. While patients suffering from severe symptoms may have minor changes; others may present no symptoms at all, even though endoscopy reveals gastritis.

    Diagnosis

    The doctor will take a thorough history to check for risk factors. Blood and stool tests will be ordered to help in the diagnosis of the inflammation. Endoscopy and biopsy samples may be required in some patients to rule out other underlying causes. In some cases, the doctor will also order X-rays to check structural problems in the gastrointestinal system.

    Management

    Treatment of gastritis depends on the causing agent. In case of nonsteroidal anti-inflammatory drug use, it is encouraged to stop the drug and an antacid may be prescribed to reduce symptoms. Alcohol consumption should be avoided. Gastritis due to bacterial infection will require treatment with a combination of drugs, which appears to be effective in the eradication of the bacteria. In very rare cases, surgical intervention may be needed to remove severely affected areas of the stomach.

    Outcome

    Gastritis has very good outcomes with rare complications; however, some patients may suffer from severe symptoms or bleeding.

    Prevention

    Avoiding the risk factors and preventing the underlying causes, such as excessive alcohol consumption and the use of nonsteroidal anti-inflammatory drugs will decrease the risk of developing gastritis. Washing hands regularly, making sure that food and drinks are clean, and keeping a good hygiene will prevent bacterial infections.

    Self-assessment

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    References

    1. Chey WD, Wong BC. Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007; 102: 1808-1825.
    2. Glickman JN, Antonioli DA. Gastritis. Gastrointest Endosc Clin N Am. 2001; 11: 717-740.
    3. Lanza FL. A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol. 1998; 93: 2037-2046.
    4. Larkai EN, Smith JL, Lidsky MD, et al. Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 1987; 82: 1153-1158.
    5. El-Serag HB, Talley NJ. Systemic review: the prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther. 2004; 19:643-654.
    6. Hunt RH, Xiao SD, Megraud F, et al. World Gastroenterology Organization. Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline. J Gastrointestin Liver Dis. 2011; 20: 299-304.
    7. MacMath TL. Alcohol and gastrointestinal bleeding. Emerg Med Clin North Am. 1990; 8: 859-872.
    8. Turner MA, Beachley MC, Stanley D. Phlegmonous gastritis. AJR Am J Roentgenol. 1979; 133: 527-528.
    9. Talley NJ, Vakil N. Practice Parameters Committee of the American College of Gastroenterology: guidelines for the management of dyspepsia. Am J Gastroenterol. 2005; 100: 2324-2337.
    10. Talley NJ. American Gastroenterological Association. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 2005; 129: 1753-1755.
    11. Cutler AF, Havstad S, Ma CK, et al. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology. 1995; 109: 136-141.
    12. Hirota WK, Zuckerman MJ, Adler DG, et al. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc. 2006; 63: 570-580.
    13. Kim N, Kim JJ, Choe YH, et al. Diagnosis and treatment guidelines for Helicobacter pylori infection in Korea [in Korean]. Korean J Gastroenterol. 2009; 54: 269-278.
    14. Drepper MD, Spahr L, Frossard JL. Clopidogrel and proton pump inhibitors--where do we stand in 2012?. World J Gastroenterol. May 14, 2012; 18(18): 2161-71.
    15. Laine L, Curtis SP, Cryer B, et al. Risk factors for NSAID-associated upper GI clinical events in a long-term prospective study of 34 701 arthritis patients. Aliment Pharmacol Ther. November 2010; 32(10): 1240-8.
    16. Lanza FL, Chan FK, Quigley EM, et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009; 104: 728-738.

    • Acute ascariasis in children - PB Fernando, S Balasingham - Indian Journal of Pediatrics, 1943 - Springer
    • A case of acute phlegmonous gastritis successfully treated with antibiotics - Y Iwakiri, T Kabemura, D Yasuda - Journal of clinical , 1999 - journals.lww.com
    • Acute gastritis associated with spiral organisms from cats - JP Lavelle, S Landas, FA Mitros, JL Conklin - Digestive diseases and , 1994 - Springer
    • ACHLORHYDRIA AND ACHYLIA GASTRICA, AND THEIR CONNEXION WITH THE ADDISON, S ANAEMIA-SUB-ACUTE COMBINED DEGENERATION SYNDROME - AF HURST - QJM, 1932 - Oxford Univ Press
    • Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study - O Blatchford, LA Davidson, WR Murray, M Blatchford - BMj, 1997 - bmj.com
    • Acute gastritis associated with spiral organisms from cats - JP Lavelle, S Landas, FA Mitros, JL Conklin - Digestive diseases and , 1994 - Springer
    • Acute necrotizing gastritis by Escherichia coli in a severely neutropenic patient - C Martínez-Chamorro, E Martínez - , 2002 - online.haematologica.org
    • A randomized clinical trial of analgesia in children with acute abdominal pain - MK Kim, RT Strait, TT Sato - Academic emergency , 2002 - Wiley Online Library
    • Acute gastritis associated with spiral organisms from cats - JP Lavelle, S Landas, FA Mitros, JL Conklin - Digestive diseases and , 1994 - Springer
    • A foodborne outbreak of gastroenteritis associated with Norwalk-like viruses: first molecular traceback to deli sandwiches contaminated during preparation - NA Daniels, DA Bergmire-Sweat - Journal of Infectious , 2000 - jid.oxfordjournals.org
    • A randomized clinical trial of analgesia in children with acute abdominal pain - MK Kim, RT Strait, TT Sato - Academic emergency , 2002 - Wiley Online Library
    • Acute abdominal pain - C Dang, MDP Aguilera, MDA Dang - , 2002 - geriatrics.modernmedicine.com
    • Acute esophageal necrosis: a rare syndrome - GE Gurvits, A Shapsis, N Lau, N Gualtieri - Journal of , 2007 - Springer
    • Campylobacter pylori--associated gastritis and peptic ulcer disease in children - PM Kilbridge, BB Dahms, SJ Czinn - Archives of Pediatrics & , 1988 - Am Med Assoc
    • A reappraisal of the nature and significance of chronic atrophic gastritis - RG Strickland, IR Mackay - Digestive Diseases and Sciences, 1973 - Springer
    • A randomized clinical trial of analgesia in children with acute abdominal pain - MK Kim, RT Strait, TT Sato - Academic emergency , 2002 - Wiley Online Library
    • A prospective study to determine the efficacy of antibiotics in acute pancreatitis. - WT Finch, JL Sawyers, S Schenker - Annals of surgery, 1976 - ncbi.nlm.nih.gov
    • A randomized clinical trial of analgesia in children with acute abdominal pain - MK Kim, RT Strait, TT Sato - Academic emergency , 2002 - Wiley Online Library
    • A rotavirus vaccine for prophylaxis of infants against rotavirus gastroenteritis - B De Vos, T Vesikari, AC Linhares - The Pediatric , 2004 - journals.lww.com
    • Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis - I Soykan, B Sivri, I Sarosiek, B Kiernan - Digestive diseases and , 1998 - Springer
    • Control of acute gastric mucosal hemorrhage - CA Athanasoulis, S Baum, AC Waltman - England Journal of , 1974 - Mass Medical Soc
    • Antithrombin titer in acute pancreatitis - I Innerfield, A Angrist, JW Benjamin - The American journal of medicine, 1952 - Elsevier
    • Of cagA-positive and cagA-negative Helicobacter pylori strains with patients' symptoms and gastritis in primary care patients with functional upper abdominal - M Heikkinen, K Mayo, F Megraud - Scandinavian , 1998 - informahealthcare.com
    • Acute Enteritis in Subtropical Climates - I Macgregor - British medical journal, 1946 - ncbi.nlm.nih.gov
    • Of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy: a controlled study - Y ZHOU, L QIAO, J WU, H HU - of gastroenterology and , 2002 - Wiley Online Library
    • Of direct electron microscopy, immune electron microscopy, and rotavirus enzyme-linked immunosorbent assay for detection of gastroenteritis viruses in children. - CD Brandt, HW Kim, WJ Rodriguez - Journal of clinical , 1981 - Am Soc Microbiol

    Media References

    1. Gastritis helicobacter - intermed mag, CC BY-SA 3.0

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