Gastritis

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
  • Acute cholecystitis
  • Cholangitis
  • Symptomatic cholelithiasis
  • Acalculous cholecystitis
• 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

• 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

See Also

PUD