Gastritis is inflammation of the gastric mucosa caused by any of several conditions, including Helicobacter pylori infection Helicobacter pylori Infection Helicobacter pylori is a common gastric pathogen that causes gastritis, peptic ulcer disease, gastric adenocarcinoma, and low-grade gastric lymphoma. Infection may be asymptomatic or result... read more , drugs (nonsteroidal anti-inflammatory drugs [NSAIDs], alcohol), stress, autoimmune phenomena (atrophic gastritis Autoimmune Metaplastic Atrophic Gastritis Autoimmune metaplastic atrophic gastritis is an inherited autoimmune disease that attacks parietal cells, resulting in hypochlorhydria and decreased production of intrinsic factor. Consequences... read more ), and a number of less common disorders.
(See also Overview of Acid Secretion Overview of Acid Secretion Acid is secreted by parietal cells in the proximal two thirds (body) of the stomach. Gastric acid aids digestion by creating the optimal pH for pepsin and gastric lipase and by stimulating pancreatic... read more and Overview of Gastritis Overview of Gastritis Gastritis is inflammation of the gastric mucosa caused by any of several conditions, including infection (Helicobacter pylori), drugs (nonsteroidal anti-inflammatory drugs, alcohol), stress... read more .)
This rare idiopathic disorder affects adults aged 30 to 60 and is more common among men. It manifests as a significant thickening of the gastric folds of the gastric body but not the antrum. Gland atrophy and marked foveolar pit hyperplasia occur, often accompanied by mucous gland metaplasia and increased mucosal thickness with little inflammation. Hypoalbuminemia (the most consistent laboratory abnormality) caused by gastrointestinal protein loss may be present (protein-losing gastropathy). As the disease progresses, the secretion of acid and pepsin decreases, causing hypochlorhydria.
Symptoms of Ménétrier disease are nonspecific and commonly include epigastric pain, nausea, weight loss, edema, and diarrhea.
Diagnosis of Ménétrier disease is made by endoscopy with deep mucosal biopsy or full-thickness laparoscopic gastric biopsy.
Differential diagnosis includes the following:
Lymphoma, in which multiple gastric ulcers may occur
Mucosa-associated lymphoid tissue (MALT) lymphoma Mucosa-associated lymphoid tissue (MALT) lymphoma Gastritis is inflammation of the gastric mucosa caused by any of several conditions, including Helicobacter pylori infection, drugs (nonsteroidal anti-inflammatory drugs [NSAIDs], alcohol),... read more , with extensive infiltration of monoclonal B lymphocytes
Gastrinoma Gastrinoma A gastrinoma is a gastrin-producing tumor usually located in the pancreas or the duodenal wall. Gastric acid hypersecretion and aggressive, refractory peptic ulceration result (Zollinger-Ellison... read more (Zollinger-Ellison syndrome) with associated gastric fold hypertrophy
Cronkhite-Canada syndrome, a mucosal polypoid protein-losing syndrome associated with diarrhea
Various treatments have been used, including anticholinergics, antisecretory drugs, and corticosteroids, but none have proved fully effective. Partial or complete gastric resection may be necessary in cases of severe hypoalbuminemia.
Extensive infiltration of the mucosa, submucosa, and muscle layers with eosinophils often occurs in the antrum. It is usually idiopathic but may result from nematode infestation.
Symptoms of eosinophilic gastritis include nausea, vomiting, and early satiety.
Diagnosis of eosinophilic gastritis is by endoscopic biopsy of involved areas.
Corticosteroids can be successful in idiopathic cases; however, if pyloric obstruction develops, surgery may be required.
Mucosa-associated lymphoid tissue (MALT) lymphoma
This rare condition is characterized by massive lymphoid infiltration of the gastric mucosa, which can grossly resemble Ménétrier disease Ménétrier disease Gastritis is inflammation of the gastric mucosa caused by any of several conditions, including Helicobacter pylori infection, drugs (nonsteroidal anti-inflammatory drugs [NSAIDs], alcohol),... read more but is distinguished on histologic examination.
Treatment of Helicobacter pylori infection Treatment A peptic ulcer is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or the first few centimeters of the duodenum (duodenal ulcer), that penetrates... read more may be curative in MALT lymphoma localized to the stomach.
Gastritis caused by systemic disorders
Sarcoidosis, tuberculosis, amyloidosis, and other granulomatous diseases can cause gastritis, which is seldom of primary importance.
Gastritis caused by physical agents
Radiation and ingestion of corrosives (especially acidic compounds) can cause gastritis. Exposure to > 6 gray of whole-body radiation (see Acute radiation syndromes Acute radiation syndromes (ARS) Ionizing radiation injures tissues variably, depending on factors such as radiation dose, rate of exposure, type of radiation, and part of the body exposed. Symptoms may be local (eg, burns)... read more ) causes marked deep gastritis, usually involving the antrum more than the corpus. Pyloric stenosis and perforation are possible complications of radiation-induced gastritis.
Infectious (septic) gastritis
Except for H. pylori infection Helicobacter pylori Infection Helicobacter pylori is a common gastric pathogen that causes gastritis, peptic ulcer disease, gastric adenocarcinoma, and low-grade gastric lymphoma. Infection may be asymptomatic or result... read more , bacterial invasion of the stomach is rare and mainly occurs after ischemia, ingestion of corrosives, or exposure to radiation. On x-ray, gas outlines the mucosa. The condition can manifest as an acute surgical abdomen and has a very high mortality rate. Surgery is often necessary.
Debilitated or immunocompromised patients may develop viral or fungal gastritis with cytomegalovirus, Candida, histoplasmosis, or mucormycosis; these diagnoses should be considered in patients with exudative gastritis, esophagitis, or duodenitis.