Gastritis: Difference between revisions
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*Eradicate H. pylori if identified in symptomatic patient | *Eradicate H. pylori if identified in symptomatic patient | ||
**Triple Therapy: PPI + [[clarithromycin]] 500mg BID + [[amoxicillin]]1g BID x 10-14d | **Triple Therapy: PPI + [[clarithromycin]] 500mg BID + [[amoxicillin]]1g BID x 10-14d | ||
***[[Metronidazole]] 500mg BID can be substituted for amoxicillin in penicillin-allergic individuals | ***[[Metronidazole]] 500mg BID can be substituted for [[amoxicillin]] in penicillin-allergic individuals | ||
**Quadruple Therapy: PPI + bismuth subsalicylate 524mg QID + [[metronidazole]] 250mg QID and [[tetracycline]] 500mg QID x 10-14d. | **Quadruple Therapy: PPI + bismuth subsalicylate 524mg QID + [[metronidazole]] 250mg QID and [[tetracycline]] 500mg QID x 10-14d. | ||
***Can be used in areas of high resistance to clarithromycin or metronidazole | ***Can be used in areas of high resistance to clarithromycin or metronidazole | ||
Revision as of 10:20, 8 September 2016
Background
- Inflammation of the stomach lining
- May occur acutely or chronically
- May lead to peptic ulcer disease
- Causes
- H. pylori
- NSAIDs
- ETOH
- Critical Illness (Cushing ulcer)
- Increased ICP, stimulation of vagal nuclei, increased secretion of gastric acid
Clinical Features
- Gnawing or burning pain in epigastric area
- Nausea, vomiting
- Early satiety, bloating
- Heartburn
Differential Diagnosis
Epigastric Pain
- GERD
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic Dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- Pulmonary embolism
Evaluation
- CBC (to rule out anemia)
- BMP, LFTs
- Lipase
- Consider:
- Acute abdominal series
- ?Barium swallow (upper GI series)
- endoscopy (most will be done as outpatient)
- RUQ US
- ECG/troponin
Management
- Cessation of NSAIDs and Etoh
- Eradicate H. pylori if identified in symptomatic patient
- Triple Therapy: PPI + clarithromycin 500mg BID + amoxicillin1g BID x 10-14d
- Metronidazole 500mg BID can be substituted for amoxicillin in penicillin-allergic individuals
- Quadruple Therapy: PPI + bismuth subsalicylate 524mg QID + metronidazole 250mg QID and tetracycline 500mg QID x 10-14d.
- Can be used in areas of high resistance to clarithromycin or metronidazole
- Triple Therapy: PPI + clarithromycin 500mg BID + amoxicillin1g BID x 10-14d
- PPI
- Generally heal ulcers faster than H2 blockers
- Omeprazole 20-40mg QD
- H2 Blockers
- Famotidine 20-40mg QD
- Ranitidine 75-150mg BID
Disposition
- Normally outpatient management, unless complication (see below)
Red Flags
Any of the following suggest need for endoscopy referral:
- Age >55yr
- Unexplained weight loss
- Early satiety
- Persistent vomiting
- Dysphagia
- Anemia or GI bleeding
- Abdominal mass
- Persistent anorexia
- Jaundice