Snapshot A 55-year-old woman with a history of osteoarthritis comes into her primary care physician's office with a complaint of new indigestion. She notes that, for the past week or so, she has been experiencing discomfort in her upper abdomen, associated with meals. This has not affected her appetite, and she has not vomited up any blood or experienced any weight loss. She denies any heartburn symptoms or substance use. Her past medical history is noteworthy for osteoarthritis in her knees, and she says she has been taking naproxen as prescribed everyday for the past year and a half. She takes no other medications and is otherwise relatively healthy. (Acute gastritis) Introduction An inflammatory condition of the stomach No universally accepted classification system the updated Sydney system (1996) is most commonly used in clinical setting based on presence of nonatrophic or atrophic tissue Most classification systems still distiguish by time course in order to characterize inflammatory cell infiltrate most likely present acute (erosive) protective mucosal barrier is disrupted resulting in inflammation represented by neutrophilic infiltration a result of login to view 10 more bullets chronic (non-erosive) marked by mix of mononuclear cells (plasma cells, lymphocytes, macrophages) there are 2 types based on location login to view 10 more bullets Presentation Symptoms recurrent upper abdominal pain hematemesis (coffee ground emesis) Evaluation Endoscopy with biopsy gold standard H. pylori detection stool antigen test urease breath test Treatment Acute gastritis lifestyle avoidance of gastric irritants (coffee, EtOH, NSAID, etc.) pharmacologic proton pump inhibitor(PPI) misoprostol (synthetic PGE1) login to view 1 more bullet Chronic gastritis H. pylori treatment antibiotic therapy login to view 4 more bullets pernicious anemia treatment vitamin B12 stress ulcer treatment sucralfate, H2 blocker, PPI