Gastritis

• It is an inflammation of the gastric mucosa. ( inner lining of the stomach)
• It is one of the most common GI problems.
• It refers to diffuse localized responses of the gastric mucosa to injury or infection.

Layers in stomach

• Mucosa
• Submucosa
• Muscle layer
• serosa

Types of Gastritis

• Acute Gastritis
• Chronic Gastritis

According to the position

• Antral gastritis
• Gastritis body of the stomach
• Pangastritis

acute gastritis

• It is short term inflammatory process that can be initiated by numerous factors in stomach
•  may last several hours to a few days.
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Acute Gastritis Etiology and Risk Factors

• Dietary indication
• Overuse of aspirin and other NSAIDs
• Excessive alcohol intake
• Bile reflux disease
• Stress
• Bacterial and fungal infection
• Old age
• Radiation therapy, chemotherapeutic damages, steroids, and digitalis.
• Excessive intake of tea, coffee, mustard, pepper, etc.
• Other disease

Pathophysiology of gastritis

• The mucosal lining of the stomach normally protects it from the action of gastric acid. This mucosal barrier is composed of prostaglandins.
• If this barrier is penetratedà gastritis occurs leading to injury to mucosa and small vessels causing edema, hemorrhage, and possible ulcer formation.

Clinical features of acute gastritis

• Abdominal epigastric discomfort, tenderness, headache, severe nausea, anorexia, vomiting and hiccupping.
• Sometimes no symptoms may occur.
• Cramping, belching, reflux, sometimes hematemesis and GI bleeding.

Chronic Gastritis

• It is a prolonged inflammation of the gastric mucosa or the stomach.
• It can result from repeated episodes of acute gastritis.

Etiology of chronic gastritis

• Helicobacter pylori (H-pylori) cause chronic atrophic gastritis 
• Gastric surgery
• Acute recurrent gastritis
• More common in older adults
• Benign or malignant ulcers of the stomach
• Autoimmune diseases
• Pernicious anemia,
• caffeine,
•  NSAIDs, alcohol,
• smoking,
• reflux of intestinal content into the stomach

Pathophysiology of chronic gastritis

Clinical features

• Anorexia
• Heart burn after eating
• Sour taste on mouth
• Feeling of fullness
• Dyspepsia
• Epigastric pain
• Vomiting
• Intolerance of spicy or fatty foods
• Mal-absorption
• Weight loss

Peptic Ulcer

• A peptic ulcer may be referred to as a gastric, duodenal, or esophageal ulcer, depending on its location.
• A peptic ulcer is an excavation (hollowed-out area) that forms in different parts of the stomach
•  mucosal wall of the stomach,
•  pylorus (the opening between the stomach and duodenum),
• duodenum (the first part of the small intestine), or in the esophagus.
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• Erosion of a circumscribed area of mucous membrane is the cause.
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• This erosion may extend as deeply as the muscle layers or through the muscle to the peritoneum.
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• Peptic ulcers are more likely to occur in the duodenum than in the stomach.
•  
• As a rule they occur alone, but they may occur in multiples.

Epidemiology

• Greatest frequency in people between 40 and 60 years of age.
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• It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants.
• After menopause, the incidence of peptic ulcers in women is almost equal to that in men.
• Etiology
• H. pylori infection (90% has this bacterium)
• The ingestion of milk and caffeinated beverages, smoking, and alcohol also may increase HCl secretion.
• Stress and eating spicy foods may make peptic ulcers worse.
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• Familial tendency also may be a significant predisposing factor.

Zollinger Ellison syndrome. 

Chronic use of NSAIDs, alcohol ingestion, and excessive smoking.

Types of peptic ulcer disease

• Gastric peptic ulcer
• Duodenal peptic ulcer

Stomach function

Digestion of food

• Storage of food
• Secretion of  gastric juices
• Secretion of digestive enzymes
• Secretion of HCL
• Secretion of Gastric hormones
• Secretion of intrinsic factor
• Absorption of water

Gastric Ulcers and Duodenal Ulcers

• DUs occur most often in the first portion of duodenum (>95%), with ~90% located within 3 cm of the pylorus.
• Malignant DUs are extremely rare.
• In contrast to DUs, GUs can represent a malignancy.
• Benign GUs are most often found along the lesser curvature in the region of pyloric antrum.
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Pathophysiology

• Duodenal Ulcer by H. Pylori Infection

Clinical manifestations

• Typical symptoms
• Epigastric pain
• Fullness
• Nausea
• Bloating
• Nocturnal pain

Alarm symptoms

• Anemia (bleeding)
• Hematemesis
• Melena
• Pyrosis (heartburn)
• Weight loss
• Persisting abdominal pain often radiating to the back