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(Gastritis - New Page)
 
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==Background==
==Background==
[[File:Gray1046.png|thumb|Stomach anatomy]]
[[File:Illu stomach2.jpg|thumb|Stomach wall anatomy]]
*Inflammation of the stomach lining
*Inflammation of the stomach lining
*May occur acutely or chronically
*May occur acutely or chronically
*May lead to [[PUD]]
*May lead to [[Special:MyLanguage/peptic ulcer disease|peptic ulcer disease]]
*Causes
*Causes
**H. pylori
**[[Special:MyLanguage/H. pylori|H. pylori]]
**NSAIDs
**[[Special:MyLanguage/NSAIDs|NSAIDs]]
**Etoh
**[[Special:MyLanguage/ETOH|ETOH]]
**Critical Illness (Cushing ulcer)
**Critical Illness (Cushing ulcer)
***Inc ICP, stimulation of vagal nuclei, inc secretion of gastric acid
***[[Special:MyLanguage/Increased ICP|Increased ICP]], stimulation of vagal nuclei, increased secretion of gastric acid
 


==Clinical Features==
==Clinical Features==
*Gnawing or burning pain in epigastric area
 
*Nausea, vomiting
*Gnawing or burning [[Special:MyLanguage/epigastric pain|epigastric pain]]
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]]
*Early satiety, bloating
*Early satiety, bloating
*Heartburn
*Heartburn


==Differential Diagnosis==
==Differential Diagnosis==
===[[Epigastric pain|Epigastric Pain]]===
*[[GERD]]
*[[Peptic ulcer disease]] with or without perforation
*[[Gastritis]]
*[[Pancreatitis]]
*[[Gallbladder Disease (Main)|Gallbladder disease]]
**[[Acute cholecystitis]]
**[[Cholangitis]]
**[[Symptomatic cholelithiasis]]
**[[Acalculous cholecystitis]]
*[[Myocardial Ischemia]]
*[[Splenic Infarction]]enlargement/rupture/aneurysm
*[[Pericarditis]]/[[Myocarditis]]
*[[Aortic Dissection]]
*[[Hepatitis]]
*[[Pyelonephritis]]
*[[Pneumonia]]
*[[Pyogenic liver abscess]]
*[[Fitz-Hugh-Curtis Syndrome]]
*Hepatomegaly due to [[CHF]]
*[[Bowel obstruction]]
*[[Pulmonary embolism]]


==Diagnosis==
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*CBC (r/o anemia)
{{Abdominal Pain DDX Epigastric}}
*BMP, LFTs
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==Evaluation==
 
[[File:PMC5316417 10120 2016 680 Fig4 HTML.png|thumb|Conventional white-light endoscopic findings for the gastric body. (a) Normal (b) Gastric mucosa with chronic atrophic gastritis associated with HP infection. Visible vessels and an absence of folds in the gastric body mucosa are characteristic of chronic atrophic gastritis.]]
*CBC (to rule out anemia)
*BMP, [[Special:MyLanguage/LFTs|LFTs]]
*Lipase
*Lipase
*?Acute abd series
*Consider:
*?Barium swallow aka upper GI series
**[[Special:MyLanguage/Acute abdominal series|Acute abdominal series]]
*?EGD, most will be outpt
**?Barium swallow (upper GI series)
*?RUQ US
**Endoscopy (most will be done as outpatient)
*?ECG and Troponin
**[[Special:MyLanguage/RUQ US|RUQ US]]
**[[Special:MyLanguage/ECG|ECG]]/[[Special:MyLanguage/troponin|troponin]]


==Treatment==
*Cessation of NSAIDs and Etoh
*Eradicate H. pylori if identified in symptomatic pt
**Triple Therapy: PPI + [[clarithromycin]] 500mg BID + [[amoxicillin]]1g BID x 10-14d
***[[Metronidazole]] 500 mg BID can be substituted for amoxicillin in penicillin-allergic individuals
**Quadruple Therapy:  PPI + bismuth subsalicylate 524 mg QID + [[metronidazole]] 250 mg QID and [[tetracycline]] 500 mg QID x 10-14d.
***Can be used in areas of high resistance to clarithromycin or metronidazole


*PPI
==Management==
**Generally heal ulcers faster than H2 blockers
 
**[[Omeprazole]] 20-40mg QD
*Cessation of [[Special:MyLanguage/NSAIDs|NSAIDs]] and [[Special:MyLanguage/ETOH|ETOH]]
*H2 Blockers
*Eradicate [[Special:MyLanguage/H. pylori|H. pylori]] if identified in symptomatic patient
**[[Famotidine]] 20-40mg QD
**Triple Therapy: [[Special:MyLanguage/PPI|PPI]] + [[Special:MyLanguage/clarithromycin|clarithromycin]] 500mg BID + [[Special:MyLanguage/amoxicillin|amoxicillin]]1g BID x 10-14d
**[[Ranitidine]] 75-150mg BID
***[[Special:MyLanguage/Metronidazole|Metronidazole]] 500mg BID can be substituted for [[Special:MyLanguage/amoxicillin|amoxicillin]] in penicillin-allergic individuals
**Quadruple Therapy:  [[Special:MyLanguage/PPI|PPI]] + [[Special:MyLanguage/bismuth subsalicylate|bismuth subsalicylate]] 524mg QID + [[Special:MyLanguage/metronidazole|metronidazole]] 250mg QID and [[Special:MyLanguage/tetracycline|tetracycline]] 500mg QID x 10-14d.
***Can be used in areas of high resistance to [[Special:MyLanguage/clarithromycin|clarithromycin]] or [[Special:MyLanguage/metronidazole|metronidazole]]
 
*[[Special:MyLanguage/PPI|PPI]]
**Generally heal ulcers faster than [[Special:MyLanguage/H2 blocker|H2 blocker]]s
**[[Special:MyLanguage/Omeprazole|Omeprazole]] 20-40mg QD
*[[Special:MyLanguage/H2 blocker|H2 blocker]]s
**[[Special:MyLanguage/Famotidine|Famotidine]] 20-40mg QD
**[[Special:MyLanguage/Ranitidine|Ranitidine]] 75-150mg BID
 


==Disposition==
==Disposition==
*Normally outpatient management, unless complication (see below)
*Normally outpatient management, unless complication (see below)


===Red Flags===
===Red Flags===
Any of the following suggest need for endoscopy referral:
Any of the following suggest need for endoscopy referral:
*Age >55yr
*Age >55yr
*Unexplained weight loss
*Unexplained weight loss
*Early satiety
*Early satiety
*Persistent vomiting
*Persistent [[Special:MyLanguage/vomiting|vomiting]]
*Dysphagia
*[[Special:MyLanguage/Dysphagia|Dysphagia]]
*Anemia or GI bleeding
*[[Special:MyLanguage/Anemia|Anemia]] or [[Special:MyLanguage/GI bleeding|GI bleeding]]
*Abdominal mass
*Abdominal mass
*Persistent anorexia
*Persistent anorexia
*Jaundice
*[[Special:MyLanguage/Jaundice|Jaundice]]
 


==See Also==
==See Also==
[[PUD]]
 
*[[Special:MyLanguage/PUD|PUD]]
 


==References==
==References==
<references/>
<references/>
[[Category:GI]]
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Revisión actual - 22:55 4 ene 2026


Background

Stomach anatomy
Stomach wall anatomy


Clinical Features


Differential Diagnosis

Epigastric Pain


Evaluation

Conventional white-light endoscopic findings for the gastric body. (a) Normal (b) Gastric mucosa with chronic atrophic gastritis associated with HP infection. Visible vessels and an absence of folds in the gastric body mucosa are characteristic of chronic atrophic gastritis.


Management


Disposition

  • Normally outpatient management, unless complication (see below)


Red Flags

Any of the following suggest need for endoscopy referral:


See Also


References

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