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    Gastritis: Palangka Raya University Faculty of Medicine

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    This document discusses gastritis, including: 1. It defines gastritis and classifies it as acute or chronic. Acute gastritis develops shortly after exposure to injurious substances, while chronic gastritis refers to long-standing inflammation. 2. The main causes of acute gastritis are stress, alcohol, NSAIDs, and H. pylori infection, which can cause mucosal damage through various mechanisms. 3. Chronic gastritis has several proposed classifications and is often caused by long-term H. pylori infection, which can induce autoimmune responses, or duodenal reflux damaging the gastric mucosa. Diagnosis requires biopsy and treatment focuses

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    Gastritis: Palangka Raya University Faculty of Medicine

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    22 views32 pages
    This document discusses gastritis, including: 1. It defines gastritis and classifies it as acute or chronic. Acute gastritis develops shortly after exposure to injurious substances, while chronic gastritis refers to long-standing inflammation. 2. The main causes of acute gastritis are stress, alcohol, NSAIDs, and H. pylori infection, which can cause mucosal damage through various mechanisms. 3. Chronic gastritis has several proposed classifications and is often caused by long-term H. pylori infection, which can induce autoimmune responses, or duodenal reflux damaging the gastric mucosa. Diagnosis requires biopsy and treatment focuses

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    This document discusses gastritis, including: 1. It defines gastritis and classifies it as acute or chronic. Acute gastritis develops shortly after exposure to injurious substances, while chronic gastritis refers to long-standing inflammation. 2. The main causes of acute gastritis are stress, alcohol, NSAIDs, and H. pylori infection, which can cause mucosal damage through various mechanisms. 3. Chronic gastritis has several proposed classifications and is often caused by long-term H. pylori infection, which can induce autoimmune responses, or duodenal reflux damaging the gastric mucosa. Diagnosis requires biopsy and treatment focuses

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    Download as ppt, pdf, or txt
    22 views32 pages

    Gastritis: Palangka Raya University Faculty of Medicine

    Uploaded by

    Anonym
    This document discusses gastritis, including: 1. It defines gastritis and classifies it as acute or chronic. Acute gastritis develops shortly after exposure to injurious substances, while chronic gastritis refers to long-standing inflammation. 2. The main causes of acute gastritis are stress, alcohol, NSAIDs, and H. pylori infection, which can cause mucosal damage through various mechanisms. 3. Chronic gastritis has several proposed classifications and is often caused by long-term H. pylori infection, which can induce autoimmune responses, or duodenal reflux damaging the gastric mucosa. Diagnosis requires biopsy and treatment focuses

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    Gastritis

    Lecture

    Palangka Raya University


    Faculty of Medicine 1
    Gastritis
    Definition:
    A wide variety of inflammatory or hemorrhagic
    conditions of gastric mucosa.

    Gastritis is mostly a histological term that needs


    biopsy to be confirmed

    2
    Classification
    Acute Gastritis Chronic gastritis
     Simple
     Superficial
     Erosive & Hemorrhagic
     Atrophic
     Phlegmonous
     (Hypertrophic)
     Corrosive

    •Acute vs. chronic


    –Acute referring to short term inflammation
    –Acute referring to neurophilic infiltrate

    –Chronic referring to long standing forms


    –Chronic referring to mononuclear cell infiltrate especially
    lymphocyte and macrophages
    3
    Anatomical site
    CARDIA 贲门

    MUCOUS SECRETING
    ENDOCRINE BODY 胃体

    SPECIALISED SECRETORY
    PARIETAL – ACID
    CHIEF - PEPSINOGEN
    ENDOCRINE HIST,
    SOMASTATIN

    ANTRUM 胃窦

    MUCOUS SECRETING
    ENDOCRINE
    GASTRIN, 5HT 4
    Acute Gastritis
    Developing shortly exposure to various

    injurious substances or following

    depression in mucosal blood flow

    5
    Etiology and Pathogenesis
     Stress
     Shock ;
     Sepsis ;
     Burn;
     CNS Trauma or Surgery
     Renal, Hepatic or Respiratory Failure
     Alcohol
     NSAIDs (non-steroidal anti-inflammatory drugs)
     Bacteria and Toxin (Helicobacter pylori)

    6
    Stress Related Gastric Mucosa Damage

     Mucosa ischemia ;
    thromboxane A2 , leukotriene C4
     Inhibition of epithelial renewal ;
     Impairment of gastric mucosa barrier ;
     Hydrogen ion back-diffusion ;
     Free radicals

    7
     Alcohol and Gastritis
    Alcohol is lipid-soluble, high concentration
    of ethanol transverses gastric mucosa and
    results in mucosa damage.

     NSAIDs and Gastritis


    Inhibiting synthesis of
    prostaglandins
    8
    Clinical Manifestations

    Acute Simple Gastritis

     Epigastric Pain or discomfort


     Anorexia
     Nausea and Vomiting

    9
    Clinical Manifestations

    Acute Erosive & Hemorrhagic Gastritis


     Upper GI Bleeding
     Hematemesis;
     Melena;
     Occult Blood in Stool

    10
    Definite Diagnosis: Emergency Endoscopy

    11
    ACUTE GASTRITIS - MORPHOLOGY

    Mucosal congestion,
    oedema, inflammation &
    ulceration

    12
    Two Special Terms in Acute Erosive &
    Hemorrhagic Gastritis

     Cushing Ulcer
    Erosions and ulcers associated with CNS
    trauma or surgery

     Curling Ulcer
    Erosions and ulcers associated with burn

    13
    Treatment
     Remove offending agents
     Treat predisposing conditions
     Symptomatic treatment
     Protect gastric mucosa: Sucralfate

    14
    Treatment
     Inhibit or neutralize gastric acid :
     Antacids
     H2-receptor antagonists (H2-RAs)
    Cimetidine, Ranitidine , Famotidine
     Proton pump Inhibitors (PPIs)
    Omaprazole, Lansoprazole,
    Pantoprazole, Rabeprazole,
    Esoprazole
    15
    Prevention
     Avoid offending agents
     Prophylactic use of acid-inhibiting
    or mucosa-protecting drugs:
     Sucralfate;
     H2-RAs;
     PPIs
    16
    Chronic Gastritis

    17
    Classification
    1. Whitehead (1972)

    Superficial

    Chronic Gastritis
    Atrophic

    18
    2. Strickland (1973)

    Type A
    Atrophic Gastritis
    Type B

    19
    20
    Classification of CAG by Strickland
    Features Type A Type B
     Morphology
    antrum normal atrophy
    corpus diffuse multifocal
     Serum gastrin
     Gastric acid secretion anacidity hypoacidity
     Gastric autoantibodies 90% 10%
     Frequency in 90% 10%
    pernicious anemia
     proposed etiological autoimmunity mucosa
    factors genetic component irritants21
    3. Sydney System (1990)

    4. Updated Sydney System (1996)

    22
    23
    5. National consensus
    重庆共识 （1982）
     Superficial
     Atrophic
     (Hypertrophic)
    Location: antrum, corpus or pan-;
    Severity: mild, moderate, severe;
    Activity: active, quiescent;
    Metaplasia: intestinal, pseudopyloric
    井冈山共识 （2000）
    上海共识 （2006） 24
    Etiology and Pathogenesis

    25
    1. Helicobacter pylori Infection:
    (Koch’s postulates)
     High prevalence of Hp infection in patients
    with chronic active gastritis (80-95%).

     Hp infection is associated with gastric mucosal


    inflammation.
     Distribution
     Inflammation subsides after eradication of Hp

    Studies in volunteer and animal models.

    26
    27
    28
    Antigenic Mimicry

    Lipopolysaccharide
    Heat Shock Protein

    Gastric Epithelium,
    G cells,
    Antibody Canaliculi of Parietal Cells,
    H+, K+-ATPase
    29
    2. Immunological Factors
     Parietal cell antibody (PCA)and intrinsic factor
    antibody (IFA) are in 90% of patients with type
    A atrophic gastritis and pernicious anemia.
     Pernicious anemia is also associated with other
    autoimmune diseases:
     Hashimoto’s thyroiditis;
     Diabetes mellitus;
     Vitiligo 白癫风

    30
    3. Duodenal-Gastric Reflux

    (a) Dysfunction of pyloric sphincter (b) After Partial Gastrectomy

    31
    Mechanisms of Gastric Mucosal Damage
    by Duodenal Contents
    Bile Pancreatic
    Enzymes
    Lecithin
    卵磷脂

    Lysolecithin
    溶血卵磷脂

    Damage of Gastric Mucosal Barrier


    32

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