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 NSAIDs ↓ gastric mucosa production via ↓ PGE2 consider in patients with chronic pain conditions EtOH common in alcoholics uremia burns → Curling's ulcer brain injury ↑ vagal stimulation results in ↑ H+ production Anisakis worm infestation chronic (non-erosive) marked by mix of mononuclear cells (plasma cells, lymphocytes, macrophages) there are 2 types based on location Type A (fundus/body) pernicious anemia is most common cause associated with macrocytic anemia ↓ acid production (achlorhydria) resulting in hypergastrinemia also associated with other autoimmune conditions (e.g. Hashimoto's thyroiditis) ↑ risk for gastric carcinoma Type B (antrum/pylorus) caused by infection (H. pylori, herpes, CMV) also caused by chronic NSAID use ↑ risk of MALT lymphoma and adenocarcinoma 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) contraindicated in pregnancy as it has abortifacient properties Chronic gastritis H. pylori treatment antibiotic therapy 2 stages PPI + amoxicillin PPI + clarithromycin + tinidazole bismuth compound (Pepto-Bismol) pernicious anemia treatment vitamin B12 stress ulcer treatment sucralfate, H2 blocker, PPI