GASTRITIS ACID PEPTIC DISEASE BLEEDING PEPTIC ULCERS GASTRITIS
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Inflammation associated with mucosal injury in stomach
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Histological diagnosis, although it can be recognized sometimes at endoscopy
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Gastritis is usually due to infectious agents (such as Helicobacter pylori) and autoimmune and hypersensitivity reactions.
CLASSIFICATION
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Acute vs. chronic – Acute refers to short term inflammation – Acute referring to neutrophilic infiltrate – –
Chronic referring to long standing forms Chronic referring to mononuclear cell infiltrate especially lymphocyte and macrophages
COMMON CAUSES
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Acute Gastritis – Aspirin, NSAIDs – H. Pylori (initial infection) – Alcohol – Iron preparations – Severe physiological stress, e.g., burns, multi-organ failure, CNS trauma – Bile reflux, e.g. Following gastric surgery – Viral Infections, e.g. CMV, HSV in AIDS Chronic Non-specific Gastritis – H. Pylori Infections – Autoimmune (Pernicious Anemia) – Post-gastrectomy Chronic Specific Forms – Infection e.g. CMV, Tuberculosis – Gastrointestinal diseases e.g. Crohn‟s Disease – Systemic diseases e.g. Sarcoidosis – Idiopathic, e.g. Granulomatous gastritis
PRESENTATION
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May be asymptomatic Dyspepsia Anorexia
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Nausea or vomiting Hematemesis or melena
PEPTIC ULCER DISEASE
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The term refers to an ulcer in lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to the stomach. It may be acute or chronic, both penetrate muscularis mucosae. Acute Ulcers do not show evidence of fibrosis
EPIDEMIOLOGY
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Prevalence decreasing in western communities High prevalence in developing countries Male to female ratio for gastric ulcer is 2:1 or less. For duodenal ulcers male to female ratio varies from 5:1 to 2:1.
LOCATION
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Chronic gastric Ulcers – usually single – 90% located at lesser curvature within antrum or at junction between body and antral mucosa
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Chronic duodenal ulcers – usually occur in first part of duodenum – 50% are on anterior wall
PRESENTATION
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History of relapse and remission lasting for many years Recurrent abdominal pain, localized at epigastrium, episodic in occurrence, associated with food in take. Anorexia Vomiting and nausea Sense of undue repletion after meals Clinically „silent‟ ulcer first time may present with anemia Abrupt hematemesis or acute perforation can also be first presentation.
H. PYLORI
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Helicobacter pylori is a spiral shaped, micro-aerophilic, gram negative bacterium measuring approximately 3.5 microns in length and 0.5 microns in width
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Helicobacter pylori is the most common chronic bacterial infection in humans.
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50 percent of the world's population is affected
PATHOPHYSIOLOGY
Urease • Urease forms ammonia and bicarbonate that neutralize gastric acid and form a protective cloud around the organism •
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Urease appears to be vital for its survival and colonization; it is produced in abundance, making up more than 5 percent of the organism's total protein weight.
Helicobacter pylori is a spiral shaped, micro-aerophilic, gram negative bacterium measuring approximately 3.5 microns in length and 0.5 microns in width
EPIDEMIOLOGY
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Helicobacter pylori is the most common chronic bacterial infection in humans.
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50 percent of the world's population is affected
RISK FACTORS
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Density of housing Overcrowding Number of siblings Sharing a bed Lack of running water
Have all been linked to a higher acquisition of H. Pylori infection
TRANSMISSION
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The route by which infection occurs remains unknown person-to-person transmission of H. pylori through either fecal/oral or oral/oral exposure seems most likely Humans appear to be the major reservoir of infection; however, bacteria have been isolated from primates in and from domestic cats and in milk and gastric tissue of sheep
INVESTIGATIONS
• Endoscopy – preferred • Biopsy – for histopathology and to rule out malignant cause DIAGNOSIS OF H. PYLORI INFECTION
Disdavantages
Advantages
Test
Lack sensitivity & specificity, cannot diff. Between old & new infection
Rapid kits Good for population studies
Serology
Expensive
Highly specific & sensitive
C-urea breath test
acceptability
Cheap, specific
Fecal antigen test
False negative may occur
Sensitive & specific
Histology
Sensitivity 85%
Cheap, quick, specific
Rapid urease test
Slow
Gold standard Antibiotic sensitivity
Microbiological culture
Non Invasive
Invasive
MISCELLANEOUS INVESTIGATIONS
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FBC – Anemia
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UCE – dehydration
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Barium Swallow
MANAGEMENT
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Life Style – Encourage weight loss – Smoking cessation – Small regular meals – Avoid hot beverages, alcohol, citrus food, coffee, tea, chocolates – Avoid eating
