Snap Shot A 35-year-old male presents to his primary care physician complaining of epigastric pain, nausea, vomiting, all worsened by eating. Introduction Inflammation of the gastric lining, which can present either chronically or acutely Acute gastritis rapidly developing lesions usually located in gastric antrum causes include NSAID overuse EtOH abuse pathophysiologic stress (i.e. burns, CNS injury) H. pylori infection Herpes, CMV Chronic gastritis Type A slowly developing lesions usually occurs in gastric fundus caused by anti-parietal cell antibodies associated with pernicious anemia patients at increased risk of developing adenocarcinoma Type B slowly developing lesions usually occurs in the gastric antrum caused by NSAID use H. pylori infection often asymptomatic associated with increased risk of developing PUD Patients with chronic gastitis are at increased risk of developing gastric carcinoma Presentation Symptoms may be asymptomatic epigastric pain nausea/vomiting bloody vomiting dark stools Physical exam epigastrum may be tender to palpation may have positive stool guiaic Evaluation Upper endoscopy with biopsy may identify specific area of inflammation Urease breath test used to diagnose and confirm eradication of H. pylori infection Serum IgG antibody positive in exposure to H. pylori (not indicative of present infection) H. pylori stool antigen may help identify infection, and useful in testing for eradication Differential Gastric ulcer, upper GI bleed, gastric carcinoma, pancreatitis Treatment Medical management treat underlying condition H. pylori infection ("triple therapy") proton pump inhibitor (PPI) amoxicillin and clarithromycin (or Flagyl) bismuth compound (Pepto-Bismol) pernicious anemia vitamin B12 stress ulcer sucralfate H2 blocker or PPI stop offending agents COX inhibitors (NSAIDS) Prognosis, Prevention, and Complications Prognosis very good to excellent if identifed and treated appropriately Prevention avoid known offending agents, treat ICU/burn patients prophylactically Complications gastric carcinoma