Understanding Gastritis and Peptic Ulcers

Aug 31, 2024

Mindmap

Stomach Disorders: Gastritis and Peptic Ulcer Disease

Introduction

  • Discussion on stomach disorders: gastritis and peptic ulcer disease.
  • Importance of differentiation due to similar pathophysiology and symptoms.

Gastritis

Definition

  • Inflammation of the stomach lining, primarily involving the mucosa (antrum).
  • Characterized by mucosal inflammation and small erosions.

Microscopic Features

  • Layers involved: Epithelial layer, lamina propria, muscularis mucosa.
  • Erosions: Shallow, do not penetrate muscularis mucosa.
  • Inflammation: Generalized mucosal inflammation.
  • Mucus Layer: Thin protective mucus layer.

Symptoms

  • Epigastric abdominal pain, not significantly altered by food intake.

Pathophysiology

  • Causes: NSAIDs, ethanol, H. pylori, stress (Curling's and Cushing's ulcers), autoimmune.
  • Mechanisms:
    • NSAIDs/Ethanol: Decrease prostaglandin production, increase hydrochloric acid, decrease alkaline mucus.
    • H. pylori: Increases gastrin and hydrochloric acid, urease enzyme increases ammonia, cytotoxicity to mucosal cells.
    • Stress Ulcers: Hypovolemia from burns/sepsis (Curling's), increased vagal activity/ICP (Cushing's).
    • Autoimmune Gastritis: Antibodies attack parietal cells, causing atrophy and affecting intrinsic factor production.

Peptic Ulcer Disease (PUD)

Definition

  • Involves stomach and duodenum, with more common duodenal ulcers.
  • True ulcers that extend beyond muscularis mucosa.

Symptoms

  • Epigastric abdominal pain, with food-related changes (gastric → pain increases; duodenal → pain decreases).

Microscopic Features

  • Deep submucosal ulcers, inflammation, and thin mucus lining.

Pathophysiology

  • Causes: Similar to gastritis (NSAIDs, ethanol, H. pylori, gastrinoma).
  • Gastrinoma (Zollinger-Ellison Syndrome): Gastrin-secreting tumor causing refractory duodenal ulcers.

Complications

Gastritis

  • Generally benign but can cause minor GI bleeding.
  • Atrophic gastritis can lead to gastric cancer risk and B12 deficiency.

Peptic Ulcer Disease

  • GI bleeding: Erosion into gastric arteries (left gastric, gastroduodenal).
  • Perforation: Serosal erosion leading to pneumoperitoneum and peritonitis.
  • Gastric Outlet Obstruction (Goo): Antral fibrosis & edema causing vomiting, pain, succussion splash.
  • Chronic Complications: Risk of gastric adenocarcinoma, Malt lymphoma from chronic inflammation.

Diagnosis

Initial Assessment

  • Rule out perforation with imaging (e.g., abdominal x-ray for pneumoperitoneum).
  • Look for alarm features (GI bleeding, weight loss, nausea, vomiting).

Tests

  • H. pylori: Stool antigen, urea breath test, biopsy with urease test or GM cysteine stain.
  • Zollinger-Ellison Syndrome: Serum gastrin levels, secretin suppression test.

Treatment

General Approach

  • Acid suppression (PPIs).
  • Enhance mucus barrier (sucralfate, misoprostol).
  • Eradicate H. pylori (CAP or quadruple therapy).

Complications Management

  • GI Bleed: EGD for diagnosis and treatment.
  • Perforation: Surgical intervention (laparotomy, Graham patch).
  • Gastric Outlet Obstruction: Endoscopic dilation.

Summary

  • Reviewed causes, symptoms, diagnosis, treatment of gastritis and peptic ulcer disease.
  • Emphasized differences in pathophysiology and management.

This summary provides a comprehensive guide on understanding and managing gastritis and peptic ulcer disease, focusing on differentiation, diagnosis, and treatment strategies.