From the Guidelines
Vomiting and antral thickening are most commonly caused by gastritis, particularly chronic forms, which lead to inflammation and thickening of the stomach lining, especially in the antrum. This condition can be triggered by various factors, including H. pylori infection, NSAID use, and psychological factors such as stress, as noted in the British Society of Gastroenterology guidelines on the management of functional dyspepsia 1. Other potential causes of vomiting and antral thickening include peptic ulcer disease, gastric outlet obstruction, and less commonly, gastric cancer. The diagnosis of antral thickening can be made through imaging studies, such as CT scans, which may show gastric or duodenal wall thickening due to submucosal edema, mucosal hyperenhancement, or fat stranding due to inflammation, as described in the ACR Appropriateness Criteria for epigastric pain 1. Treatment of vomiting and antral thickening depends on the underlying cause, but typically includes proton pump inhibitors like omeprazole 20-40mg daily for 4-8 weeks to reduce stomach acid, as well as lifestyle changes such as avoiding irritants like alcohol, NSAIDs, and spicy foods. If H. pylori is present, triple therapy with amoxicillin, clarithromycin, and a PPI for 14 days is recommended, as noted in the British Society of Gastroenterology guidelines 1. It is essential to rule out malignancy through endoscopy with biopsy, especially in cases of antral thickening, as chronic inflammation can lead to cellular proliferation and fibrosis in the gastric wall, resulting in the characteristic thickened appearance on imaging studies. In some cases, psychological or behavioral therapies may be beneficial in managing symptoms, as they can help reduce the abnormal sensitivity of the nerves in the upper gut, as suggested in the British Society of Gastroenterology guidelines 1. Overall, a comprehensive approach to diagnosis and treatment, taking into account the potential causes and underlying factors, is necessary to effectively manage vomiting and antral thickening.
From the Research
Causes of Vomiting and Antral Thickening
- Vomiting and antral thickening can be caused by various factors, including Helicobacter pylori infection, which is a major causal factor in chronic gastritis 2, 3, 4.
- H. pylori infection can lead to a chronic, usually lifelong, inflammation of the gastric mucosa, which may gradually progress to atrophy and increase the risk of peptic ulcer and gastric cancer 2, 3.
- Antral thickening can also be caused by hypertrophic gastritis, which is a benign condition that can mimic the morphology of Borrmann type 4 advanced gastric cancer 5.
- Prostaglandin-induced foveolar hyperplasia can also cause antral mucosal hypertrophy and thickening, leading to gastric-outlet obstruction and vomiting 6.
- The risk of peptic ulcer and gastric cancer in patients with H. pylori gastritis can be increased by various factors, including the severity of gastritis, host- and bacteria-related factors, and the presence of antral atrophy 2, 3.
Associated Conditions
- H. pylori infection is associated with chronic antral gastritis in both peptic ulcer disease patients and healthy population 4.
- Antral gastritis can be classified as active chronic gastritis and superficial chronic gastritis, and H. pylori infection is highly associated with both types of gastritis 4.
- Hypertrophic pyloric stenosis can be a complication of antral thickening and hypertrophy, and can cause vomiting and gastric-outlet obstruction 6.
- Borrmann type 4 advanced gastric cancer can also cause antral thickening and vomiting, and can be differentiated from hypertrophic gastritis by endoscopic ultrasonography and biopsy 5.