Clinical Signs of Gastritis
Gastritis is typically asymptomatic or presents with nonspecific symptoms, with endoscopic evaluation and biopsies being essential for definitive diagnosis and risk stratification. 1
Clinical Presentation
Gastritis often presents with the following signs and symptoms:
- Nonspecific symptoms that may occur later in the disease course 2
- Epigastric pain - more commonly associated with chronic H. pylori-negative gastritis in the gastric body 3
- Nausea and vomiting - can be managed with dopamine receptor antagonists (prochlorperazine, haloperidol, metoclopramide, olanzapine) 2
- Upper GI bleeding - acute hemorrhagic gastritis accounts for approximately 25% of upper GI bleeding cases 4
It's important to note that gastritis is often asymptomatic, with a population-based study showing that 40.2% of individuals had histological gastritis, but many were asymptomatic 3.
Diagnostic Approach
Endoscopic Evaluation
- Obtain topographical biopsies from both body and antrum/incisura in separately labeled jars 2, 1
- Look for characteristic endoscopic features:
Laboratory Testing
H. pylori testing - essential for all individuals with atrophic gastritis 2, 1
For suspected autoimmune gastritis:
Types of Gastritis and Specific Signs
H. pylori-Associated Gastritis
- Most common etiology of atrophic gastritis 2
- May progress to gastric intestinal metaplasia, dysplasia, and ultimately gastric adenocarcinoma 2
- Risk factors: age, tobacco use, high-salt diet, and possibly chronic bile acid reflux 2
Autoimmune Gastritis
- Less common (0.5-2% prevalence) 2
- Characterized by corpus-predominant atrophic gastritis 2
- Late-stage manifestation is pernicious anemia with vitamin B12 deficiency and macrocytic anemia 2
- Higher prevalence in patients with other autoimmune diseases, especially autoimmune thyroid disease 2, 1
- More common in women than men 2
Acute Hemorrhagic Gastritis
- Important cause of upper GI bleeding 4
- Predisposing conditions: alcohol abuse, portal hypertension, NSAID use, physiologic stress in ICU patients 4
Management Approach
H. pylori Eradication
- All individuals with atrophic gastritis should be tested and treated for H. pylori if positive 2, 1
- Recommended regimen: Triple therapy with amoxicillin, clarithromycin, and PPI for 14 days (80-90% cure rate) 1
- Confirm successful eradication using non-serological testing at least 4 weeks after treatment 2, 1
Nutritional Support
- Evaluate for iron and vitamin B12 deficiencies in all patients with atrophic gastritis, especially if corpus-predominant 2, 1
- Provide appropriate supplementation for deficiencies 1
Acid Suppression
- Proton pump inhibitors (like omeprazole) or H2 receptor antagonists for symptomatic relief, especially for gastroesophageal reflux 2, 5
- For gastritis related to NSAIDs, discontinue the offending agent if possible 4
Surveillance
- For advanced atrophic gastritis: Consider surveillance endoscopy every 3 years 2, 1
- For autoimmune gastritis: Surveillance interval should be individualized based on risk assessment 2
- For patients with autoimmune gastritis: Screen for type 1 gastric neuroendocrine tumors 2, 1
Common Pitfalls to Avoid
- Overlooking H. pylori infection - Always test for H. pylori in patients with gastritis 2, 1
- Missing nutritional deficiencies - Evaluate for iron and vitamin B12 deficiencies, especially in corpus-predominant gastritis 2
- Failing to consider associated autoimmune conditions - Screen for autoimmune thyroid disease in patients with autoimmune gastritis 2, 1
- Inadequate biopsy sampling - Obtain biopsies from both body and antrum/incisura in separately labeled jars 2, 1
- False negative H. pylori testing - Avoid testing within 4 weeks of antibiotics or 2 weeks of PPI use 1
By understanding the clinical signs and appropriate diagnostic and management strategies for gastritis, clinicians can effectively identify and treat this common condition, potentially preventing progression to more severe complications like peptic ulcer disease or gastric cancer.