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Gastritis

Gastritis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Inflammatory response of gastric mucosa to injury—“gastritis”
  • 3 lines of defense of gastric mucosa:
    • Mucous layer that forms protective pH gradient
    • Surface epithelial cells that can repair small defects
    • Postepithelial barrier that neutralizes any acid that has traversed 1st 2 layers
  • No definite link between histologic gastritis and dyspeptic symptoms
  • Epithelial cell damage with no associated inflammation—“gastropathy”

Etiology

  • Common causes of gastritis: Infections, autoimmune, drugs (i.e., cocaine), hypersensitivity, stress
  • Common causes of gastropathy: Endogenous or exogenous irritants, such as bile reflux, alcohol, or aspirin and NSAIDs, ischemia, stress, chronic congestion
  • Acute gastritis:
    • Stress (sepsis, burns, trauma):
      • Decrease in splanchnic blood flow leading to decreased mucus production, bicarbonate secretion, and prostaglandin synthesis
      • Results in mucosal erosions and hemorrhage
    • Alcohol:
      • Induces production of leukotrienes that cause microvascular stasis, engorgement, and increased vascular permeability
      • Leads to hemorrhage
    • NSAIDs, including aspirin:
      • Interfere with prostaglandin synthesis, leading to similar cascade as induced by alcohol
      • Results in mucosal erosions
    • Steroids
  • Chronic gastritis:
    • Produced by Helicobacter pylori
    • Mechanism of H. pylori unclear:
      • Gram-negative spiral bacteria found in gastric mucous layer
      • Contains enzyme urease that allows it to change pH level (alkaline) of its microenvironment

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Citation

Rosen, Peter, et al., editors. "Gastritis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307043/all/Gastritis.
Gastritis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307043/all/Gastritis. Accessed April 25, 2019.
Gastritis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307043/all/Gastritis
Gastritis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307043/all/Gastritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gastritis ID - 307043 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307043/all/Gastritis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -