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Erosive Gastritis

Hemorrhagic Gastritis

Erosive gastritis is a form of injury of the gastric mucosa that occurs as a result of trauma, iatrogenic and infectious factors. Dyspepsia, nausea and vomiting are reported in symptomatic patients, whereas upper or lower gastrointestinal bleeding can occur in severe cases. The diagnosis is made by endoscopy and treatment is focused on resolving the underlying cause, together with use of proton pump inhibitors or histamine-receptor antagonists.


Presentation

Patients with erosive gastritis may be initially asymptomatic, but most common symptoms include dyspepsia, nausea, vomiting and heartburn [1] [8]. The first sign, however, may be bleeding from the upper (hematemesis) and lower (melena) gastrointestinal tract and ranges from mild to severe. Symptoms usually develop within 12 hours after injury, whereas bleeding is seen after 2-5 days [1]. Acute stress gastritis is a severe form of erosive gastritis and is characterized by severe bleeding and is primarily encountered in critically ill patients as a result of hypoperfusion of the gastrointestinal tract [1].

Cough
  • The instrumental analysis followed a qualitative (pre-intervention) assessment of the symptoms by the patient: lower heartburn (in the ventricle), upper heartburn (in the oesophagus), epigastric pain, regurgitation, bloating and dry cough.[ncbi.nlm.nih.gov]
  • Coughing and ... Read Article »[icliniq.com]
  • I started t notice reflux waking me up gasping and coughing at nite here and there, but not terrible. I broke my arm and during recovery I had perplexing other symptoms come up. Extreme dry mouth, yellow coated tongue.[dailystrength.org]
Aspiration
  • Postoperative gastric aspiration indicates that the Billroth I operation is associated with far less regurgitation of upper intestinal secretions postoperatively than either the Polya operation or vagotomy and drainage.[ncbi.nlm.nih.gov]
  • Thank 1 Thank s Can one take Aspiring if he/she has erosive gastritis? Have been taking Plavix for Xience V stent for 7 months now, constant stomach pain, taken off aspirin 3.5 m ago, no change. Also Protonix (pantoprazole) 20mg a day. Dr.[healthtap.com]
Pallor
  • In addition there was also marked cortical pallor of the kidneys due to subnuclear renal tubular epithelial vacuolization (Armanni-Ebstein phenomenon).[ncbi.nlm.nih.gov]
  • Physical examination was notable for pallor and tachycardia; the cardiopulmonary examination was otherwise unremarkable and the abdominal examination was normal. A fecal occult blood test was positive.[cureus.com]
  • Their expressiveness depends on blood loss volume: pallor of skin, dizziness, lowering of arterial pressure, pulse acceleration; Dark color calla.[herbalthera.com]
Hypothermia
  • Death was, therefore, due to diabetic ketoacidosis complicated by hypothermia.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Twenty-four patients presented with abdominal pain, for which no cause other than chronic erosive gastritis was found in 20 patients. Ten patients had pain for more than 1 yr. Three patients presented with painless vomiting.[ncbi.nlm.nih.gov]
  • Generally only see after dinner fullness, pantothenic acid, belching, irregular abdominal pain and other symptoms of indigestion.[healthfrom.com]
  • Absence of abdominal pain. Gastroscopy showed an axial hernia and a small ulceration in the antrum ventriculi. The patient was treated with Pantozol/Pantoprazol for 8 weeks. A follow-up examination (gastroscopy) after 8 weeks was recommended.[pathorama.ch]
  • Symptoms - Chronic erosive gastritis * Stomach lining lesions * Damage to the stomach lining * Abdominal pain * Weight loss Causes - Chronic erosive gastritis * Infection with Helicobacter pylori * Anti-inflammatories, e.g., ibuprofen or aspirin * Alcohol[checkorphan.org]
  • Acute Gastritis, which can affect any individual, is characterized by abdominal pain, bleeding, or other gastrointestinal symptoms, like nausea, vomiting, and indigestion The treatment measures are generally symptomatic and involve the use of medications[dovemed.com]
Gastropathy
  • A patient with chronic erosive gastritis and protein-losing gastropathy is reported. Presentation was with weight loss and abdominal discomfort. There were endoscopic and radiological features of erosive gastritis.[ncbi.nlm.nih.gov]
  • […] erosions , erosion (acute) of stomach , Acute erosive gastritis (disorder) , Acute erosive gastritis , Erosion;gastric;acute , acute gastric erosions , gastritis erosive , erosive gastritis , haemorrhagic gastritis , acute hemorrhagic gastritis , erosive gastropathy[fpnotebook.com]
  • Chronic erosive gastritis with protein-losing gastropathy. ( 612216 ) Clarke A.C....Nicholson G.I. 1977[malacards.org]
  • The report shows that I have erosive gastropathy. I have been using medicines for one month. Now, for a few days, while spitting phlegm a small amount of light red blood comes out from my mouth. I also have some throat and chest pain. But, ...[icliniq.com]
Hematemesis
  • A 3 1/2-month-old male infant presented with hematemesis due to erosive gastritis following whole-cow's-milk feeding.[ncbi.nlm.nih.gov]
  • Date: 1990 Abstract: A 3 1/2 -month-old male infant presented with hematemesis due to erosive gastritis following whole-cow's-milk feeding.[ugspace.ug.edu.gh]
  • Patients suffering from acute forms may develop dyspepsia, nausea and vomiting, while severe cases present with either upper or lower gastrointestinal bleeding (hematemesis and melena, respectively).[symptoma.com]
  • […] infections (Salmonella), severe stress (trauma, burns, surgery), ischemia and shock, acid/alkali ingestion as part of suicide attempts, gastric irradiation or freezing, mechanical trauma (nasogastric tube), distal gastrectomy Major cause of massive hematemesis[pathologyoutlines.com]
  • It has a very important clinical lesson that in cases of hematemesis with acute viral hepatitis, apart from variceal bleeding, one should always think of gastritis; [8] especially when coagulation parameters and platelet count are within normal limits[mjdrdypu.org]
Melena
  • His melena disappeared, and the gastric erosions were markedly decreased.[ncbi.nlm.nih.gov]
  • Patients suffering from acute forms may develop dyspepsia, nausea and vomiting, while severe cases present with either upper or lower gastrointestinal bleeding (hematemesis and melena, respectively).[symptoma.com]
  • An 11-year-old-Hispanic boy with relapsed acute lymphocytic leukemia presented with hematemesis and melena 1 week after admission for sepsis and rhabdomyolysis. He had presyncope and presented to an outside hospital with hemoglobin 8.4 mg/dL.[journals.lww.com]
  • This includes : black tarry stools (melena) blood in the vomit (hematemesis) Erosive Gastritis Diagnosis Although the signs and symptoms and the patient’s medical history may point to gastritis, further investigations are required to confirm the diagnosis[healthhype.com]
Abdominal Cramps
  • By taking a full history, including past family history and social habits, your doctor will get a better picture what might be causing your abdominal cramping.[belmarrahealth.com]
Thrombosis
  • Pathology showed severe ulceration, necrosis, hemorrhage, inflammation, and thrombosis ( Fig. 4 ). No leukemic infiltrate was found. Subsequently, the patient did well.[journals.lww.com]
  • The purpose of the medication is prevention of future myocardial infarction and death following acute coronary syndromes and prevention of stent thrombosis . There are other medications besides Plavix (clopidogrel) that are platelet inhibitors.[healthtap.com]
Eczema
  • The presence of eosinophilic gastritis, the disappearance of symptoms after withdrawal of whole-cow's-milk feeding, and the association with facial eczema suggest that gastritis was induced by cow's milk.[ncbi.nlm.nih.gov]
Suggestibility
  • It is suggested that the efficacy of the Billroth I operation in controlling haemorrhage in the immediate postoperative period is related to this.[ncbi.nlm.nih.gov]
  • The presence of eosinophilic gastritis, the disappearance of symptoms after withdrawal of whole-cow's-milk feeding, and the association with facial eczema suggest that gastritis was induced by cow's milk.[ncbi.nlm.nih.gov]
  • In a case of secondary syphilis with gastric involvement, the clinical history and roentgenographic and gastroscopic examiniations initially suggested an infiltrative malignant neoplasm.[ncbi.nlm.nih.gov]
  • This suggests that there is a correlation between the instability of the gastric mucosa and blood group A.The operative mortality in erosive gastritis is high.[ncbi.nlm.nih.gov]
  • This limited uncontrolled study suggests the corticosteroids may be of benefit in patients with chronic erosive gastritis who fail to respond to conventional treatment.[ncbi.nlm.nih.gov]

Workup

The diagnostic workup should start with a detailed patient history that may reveal the causative agent of erosive gastritis. Previous use of NSAIDs, alcohol or history of gastritis can suggest erosive gastritis in patients having GI symptoms and the diagnosis is confirmed by endoscopy [6]. Through this procedure, a direct view into the gastric mucosa can be obtained and the site of erosion can be identified. Additional studies may include H. pylori testing, either by serology, urea breath test, fecal antigen test or microscopic identification after obtaining a biopsy of the gastric mucosa.

Treatment

Treatment principles may vary depending on the severity of symptoms and the extent of erosion. In general, first-line therapy includes administration of proton-pump inhibitors (PPIs) such as omeprazole or pantoprazole and H2-receptor blockers such as cimetidine or ranitidine [1]. Misoprostol, a prostaglandin E1 agonist, has shown to be effective in reducing the extent of symptoms [11]. Antimicrobial therapy, as well as administration of PPIs are sometimes necessary if H. pylori is the causative agent. Gefarnate is a drug that disrupts prostaglandin E2 and prostacyclin synthesis and has shown significant results in alleviating chronic erosive gastritis [12], while octreotide, a somatostatin analog, has been used in the setting of erosive gastritis associated with pancreatitis [13]. In the case of bleeding that does not respond to therapy, of if significant amounts of blood are lost, endoscopic hemostasis is necessary to stop further blood loss and several techniques are described, including adrenaline injection, thermal coagulation and band ligation procedures [14].

Prognosis

The prognosis is generally good, as treatment provides good results. When severe bleeding occurs, however, which may be the case in acute stress gastritis, it may cause significant morbidity, since the majority of patients are in intensive care and are critically ill [1].

Etiology

Although Helicobacter pylori infection is known to be the most common cause of gastritis and peptic ulcer disease, chronic use of NSAIDs are more commonly associated with erosive gastritis, as they reduce mucosal defense by inhibiting synthesis of prostaglandins [2]. Alcohol consumption, stress, radiation therapy, gastric hypoperfusion in the setting of trauma and instrumentation are also known causes of this form of gastric injury [1]. In most cases, especially if H. pylori is the cause, erosions are more frequently seen in the gastric antrum [7].

Epidemiology

Data regarding the presence of erosive gastritis is scarce and the majority of information is turned to peptic ulcer disease and gastroesophageal reflux disease (GERD). Previous studies have shown that erosive findings were found in 0.5-11% of patients who underwent endoscopic examination [8]. A multicenter study from China that included almost 9000 patients showed that more than 40% of patients who report gastrointestinal symptoms were found to have erosive changes in the gastric mucosa [6]. Diabetes mellitus is considered to be a risk factor for this condition [5]., as is high body mass index and obesity, whereas fast eating speed has also been implicated as a harmful factor [4]. An increased rate of this condition is observed in patients with cardiovascular and other somatic diseases and their correlation remains to be elucidated [9].

Sex distribution
Age distribution

Pathophysiology

Under physiological conditions, hydrochloric and various digestive enzymes are secreted in the stomach for proper food digestion and create a highly acidic environment (pH in the stomach is around 1) [2]. To protect the gastric mucosa from these vigorous conditions, mucosal cells secrete a thick layer of mucin and a layer of pH-neutral fluid containing bicarbonate [13]. Normally, this balance is constantly maintained, but in the presence of some stimuli that either enhance gastric acid secretion or reduce synthesis of protective mucosal layers, erosion occurs. Alcohol directly stimulates gastrin and hydrochloric acid secretion [10]., and Helicobacter pylori causes similar effects through its ability to survive in acidic conditions. NSAIDs are the most common iatrogenic factor that contributes to erosive gastritis, presumably due to inhibition of prostaglandins that are normally synthesized in order to repel gastric acid [2].

Prevention

At-risk patients can be prophylactically treated with either PPIs or histamine-receptor antagonists to reduce the incidence of erosive gastritis, in particularly the acute stress form [1]. Use of NSAIDs should be carefully considered, especially if chronic use is necessary, whereas heavy alcohol consumption mandates significant reductions.

Summary

Erosive gastritis is a condition in which injury of the mucosal lining of the stomach occurs. Helicobacter pylori (the causative agent of peptic ulcer disease in vast majority of cases), Campylobacter jejuni and cytomegalovirus are recognized as causative agents, but this form is more commonly associated with chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), radiation, alcohol consumption, stress and instrumentation [1]. The pathogenesis model still remains incompletely understood, but an imbalance between protective mucosal defenses and exposure to injurious factors has been proposed as the main disease mechanism [2]. Secretion of hormones such as gastrin, insulin and thyroxine, increased intragastric pressure, presence of Helicobacter pylori and increased concentrations of biliary acids contribute to disruption of the mucosa, resulting in epithelial erosions [3]. High body mass index and high eating speed or overeating are shown to be significant risk factors for all gastrointestinal diseases, including erosive gastritis [4]., as is diabetes mellitus type 2 [5]. The clinical presentation may significantly vary depending on the severity and extent of erosions. In general, erosive gastritis may be divided into acute and chronic. Patients suffering from acute forms may develop dyspepsia, nausea and vomiting, while severe cases present with either upper or lower gastrointestinal bleeding (hematemesis and melena, respectively). Bleeding may be mild or quite severe and can necessitate rapid therapeutic measures. Acute stress gastritis is a specific subtype that occurs in approximately 5% of patients that are critically ill, presumably as a result of diffuse hypoperfusion of the GI tract [1]. Chronic erosive gastritis, on the other hand, is often asymptomatic. Signs and symptoms supported by patient history and evaluation of potential risk factors such as chronic NSAID use, alcohol abuse or previous H. pylori infection, can aid the physician in making a presumptive diagnosis, but endoscopy is considered as the gold standard for diagnosis [6]. Direct visualization of erosions is achieved through this diagnostic method, after which appropriate treatment measures can be taken. Treatment depends on the severity of gastritis. Conservative measures such as fluid administration and use of proton pump inhibitors or histamine (H2)-receptor antagonists may be sufficient in patients who experience mild symptoms, while bleeding, especially in severe cases, requires endoscopic hemostasis that attempts to stop the bleeding from the eroded mucosa.

Patient Information

Erosive gastritis is a form of injury of the stomach lining that can occur due to various reasons. In contrast to classical forms of gastritis, where Helicobacter pylori is by far the most common cause, the use of non-steroidal anti-inflammatory drugs (NSAIDs), alcohol consumption, stress and radiation therapy are shown to be important causes, in addition to infection. To digest food and battle against various threats, the stomach secretes hydrochloric acid and various digestive enzymes that create a highly acidic environment, which poses a major threat to the stomach epithelium. To sustain acid pH, the mucosal lining produces abundant amounts of fluid that are pH-neutral and secretes other compounds that protect the stomach from injury. But in the case of increased gastric acid production or reduced capacity for protective fluid synthesis, which may be induced by any of the mentioned causes, injury of the epithelium occurs and symptoms may appear. In initial stages, patients may not complain of any symptoms, but indigestion, nausea and vomiting are most frequently reported. Bleeding may occur, although it is seen only in severe cases. Blood may be found in vomit or in stool and may require rapid diagnostic and therapeutic measures. To make the diagnosis, initial suspicion can be based on signs and symptoms, but to confirm erosive gastritis, endoscopy is the main diagnostic method. Endoscopy comprises insertion of a tube with a camera through the throat and into the stomach, which can easily identify the site of erosion and bleeding. Therapy depends on the severity of symptoms. Use of drugs that reduce production of gastric acid such as proton pump inhibitors or histamine-receptor antagonists is considered to be first-line therapy, whereas endoscopic management of erosions is recommended in cases of bleeding. The prognosis of erosive gastritis with proper therapy is generally good, but severe bleeding from gastric erosions requires prompt treatment, especially in the setting of acute stress gastritis, a form of erosive gastritis that is seen in patients who are severely ill due to other causes. Fluid administration and blood transfusions may be necessary to restore blood that is lost. High risk patients, such as those who are undergoing radiation therapy or those with a history of gastritis, may benefit from prophylactic use of drugs that reduce gastric acid production.

References

Article

  1. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Whitehouse Station, N.J:Merck Sharp & Dohme Corp; 2011.
  2. Aster, JC, Abbas, AK, Robbins, et al. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.
  3. Vakhrushev IaM, Nikishina EV. On the pathogenesis and treatment of erosive gastritis and duodenitis. Klin Med (Mosk). 1999;77(2):28-31.
  4. Kim M-K, Ko BJ, Kim E-Y, et al. Fast Eating Speed Increases the Risk of Endoscopic Erosive Gastritis in Korean Adults. Korean J Fam Med. 2015;36(6):300-304.
  5. Boehme MW, Autschbach F, Ell C, et al. Prevalence of silent gastric ulcer, erosions or severe acute gastritis in patients with type 2 diabetes mellitus--a cross-sectional study. Hepatogastroenterology. 2007;54(74):643-648.
  6. Du Y, Bai Y, Xie P, et al. Chronic gastritis in China: a national multi-center survey. BMC Gastroenterology. 2014;14:21.
  7. Toljamo KT, Niemelä SE, Karvonen AL, et al. Evolution of gastritis in patients with gastric erosions. Scand J Gastroenterol. 2005;40(11):1275-1283.
  8. Dal Monte PR, D'lmperio N, Barillari A, et al. Treatment of Chronic Erosive Gastritis: A Double-Blind Trial of Pirenzepine and Cimetidine. Clin Ther. 1989;11(6):762-767.
  9. Selezneva MG, Kolobov SV, Zaĭrat'iants OV, et al. Acute erosive gastropathies. Arkh Patol. 2010;72(5):57-60.
  10. Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract. Am J Gastroenterol. 2000;95(12):3374-3382.
  11. Pazzi P, Gamberini S, Scagliarini R, et al. Misoprostol for the treatment of chronic erosive gastritis: a double-blind placebo-controlled trial. Am J Gastroenterol. 1994;89(7):1007-1013.
  12. Du YQ, Su T, Hao JY, et al. Gastro-protecting effect of gefarnate on chronic erosive gastritis with dyspeptic symptoms. Chin Med J (Engl). 2012;125(16):2878-2884.
  13. Yabuki K, Maekawa T, Satoh K, et al. Extensive hemorrhagic erosive gastritis associated with acute pancreatitis successfully treated with a somatostatin analog. J Gastroenterol. 2002;37(9):737-741.
  14. Liu JJ, Saltzman JR. Endoscopic hemostasis treatment: How should you perform it? Can J Gastroenterol. 2009;23(7):484.

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Last updated: 2018-06-22 06:24