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Gastritis |
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Gastritis is characterized by inflammation of
the gastric mucosa.
Inflammatory changes in the mucosa and submucosa of the stomach are known as
gastritis, and may be either acute or chronic.
This may be assessed by endoscopic examination of the mucosa and confirmed by
biopsy.
Acute gastritis is characterized by superficial acute inflammation of the
gastric
mucosa. It is most often caused by ingested chemicals, the most common being
alcohol,
aspirin, and non-steroidal anti-inflammatory drugs such as indomethacin.
Acute erosive gastritis is characterized by focal loss of the superficial
gastric
epithelium. Patients develop dyspepsia with vomiting and, occasionally,
if the erosions are numerous, haematemesis may occur.
This pattern of acute gastritis is caused by shock, stress associated with
severe burns or raised
intracranial pressure, non-steroidal anti-inflammatory drugs, and very heavy
alcohol ingestion.
Severe necrotizing ulcerative gastritis follows suicidal ingestion of strong
alkalis and acids.
Chronic gastritis has been revealed by endoscopic examination to be more common
than formerly thought, and carries a recognized risk of development of
malignancy.
Peptic ulceration and intestinal metaplasia are complications of chronic
gastritis
Three main patterns of chronic gastritis are identified:
1 Helicobacter-associated gastritis is the most common form, arising
at any age. It is associated with the presence of bacterial colonies of the
organism
Helicobacter pylori. The organisms colonize the surface of the epithelium
beneath the thin
layer of mucus. The pyloric antrum is the most severely affected area, but
damage is also seen
in the fundus. Heliobacter is also very important in the development of duodenal
inflammation and ulceration.
2 Autoimmune chronic gastritis} is associated with an autoimmune disease
(pernicious anaemia) and is generally seen in elderly patients, in whom severe
atrophy of the
mucosa develops. Those affected have antibodies against gastric parietal cells
(90%) and
intrinsic factor (60%). The autoimmune damage to the gastric cells is associated
with
reduced gastric production of hydrochloric acid (hypochlorhydria) and failure of
absorption
of dietary vitamin B12. The vitamin B12 deficiency leads to interference with
normal
erythropoiesis in the bone marrow, and the patients develop a megaloblastic
macrocytic
anaemia (pernicious anaemia).
This pattern of gastritis particularly affects the body of the stomach.
3 Reactive gastritis, also known as reflux gastritis, occurs when alkaline
duodenal
fluid (containing bile) refluxes into the lower part of the stomach. It is
common in
people who have had previous gastric surgery to the pyloric area, which
presumably causes
incompetence of the pyloric sphincter.
This pattern of gastritis is also seen with prolonged administration of
non-steroidal
anti-inflammatory drugs, the common factor probably being direct toxic damage to
the mucus layer. |
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