History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include Helicobacter pylori infection, non-steroidal anti-inflammatory drug use, alcohol use/toxic ingestions, prior gastric surgery, critically ill patients, and autoimmune disease.[3][4][5][6][7][9][10][17][18][45]

dyspepsia/epigastric discomfort

Non-specific symptom of gastritis.[3][33]

no suspicious features of malignancy

Suspicious features include gastrointestinal (GI) bleeding, anaemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting.[4][34]

If present, they suggest GI malignancy rather than gastritis.

The risk of a person <60 years old having malignancy is considered to be very low.[33]

Other diagnostic factors

common

nausea, vomiting, and loss of appetite

Non-specific GI symptoms of gastritis include nausea, vomiting, and loss of appetite.[33]

uncommon

severe emesis

Symptom of phlegmonous gastritis.[11][12][13][14]

acute abdominal pain

Symptom of phlegmonous gastritis.[11][12][13][14]

fever

Symptom of phlegmonous gastritis.[11][12][13][14]

altered reflexes or sensory deficits

Patients may have signs and symptoms consistent with clinical vitamin B₁₂ deficiency and pernicious anaemia due to chronic gastric inflammation and mucosal atrophy in older people, or autoimmune atrophic gastritis.[3][24][25]

cognitive impairment

Patients may have signs and symptoms consistent with clinical vitamin B₁₂ deficiency and pernicious anaemia due to gastric mucosal atrophy.[3][24][25]

glossitis

Patients may have signs and symptoms consistent with clinical vitamin B₁₂ deficiency due to chronic gastric atrophy, or the 'fiery red tongue' associated with pernicious anaemia.[3][24][25]

co-existing autoimmune disease

Patients with autoimmune gastritis may have manifestations of associated autoimmune disease (e.g., thyroid disease, idiopathic adrenocortical insufficiency, vitiligo, type 1 diabetes mellitus, and hypoparathyroidism).[25]

Risk factors

strong

Helicobacter pylori infection

Acute non-erosive gastritis is most commonly due to H pylori infection.[3][4]

Chronic infection with H pylori predisposes to atrophic gastritis and autoimmune gastritis.

H pylori infection induces a severe inflammatory response with gastric mucin degradation and increased mucosal permeability that are directly cytotoxic to the gastric epithelium.[3][4]

non-steroidal anti-inflammatory drug (NSAID) use

Up to 10% to 20% of patients taking NSAIDs report symptoms of dyspepsia, although the prevalence may range from 5% to 50%.[17][18]

Factors identified as placing patients at increased risk for NSAID-related gastrointestinal (GI) complications include prior history of a GI event (peptic ulcer, haemorrhage), age >60 years, high dosage of NSAIDs, and concurrent use of corticosteroids or anticoagulants.[22][23]

NSAIDs inhibit prostaglandin production. This in turn decreases gastric mucosal blood flow with loss of the mucosal protective barrier.[3] NSAIDs inhibit prostaglandin production.

alcohol use/toxic ingestions

Alcohol is recognised as a risk factor for erosive gastritis. Alcohol promotes depletion of sulfhydryl compounds in gastric mucosa.[3][21] Phlegmonous gastritis is also associated with recent intake of large quantities of alcohol.[27]

A rare variant, emphysematous gastritis caused by Clostridium welchii, has been associated with ingestion of corrosive agents.[28]

previous gastric surgery

Previous gastric surgery (e.g., gastroduodenal or gastrojejunal anastomosis, truncal vagotomy, and pyloroplasty) or cholecystectomy may alter or impair pyloric function leading to bile regurgitation and bile-reflux gastritis.[5][6][7][8]

critically ill patients

Critically ill patients are at risk of developing stress-induced gastrointestinal bleeding.[9] The mechanism is unclear but involves decreased mucosal blood flow and loss of the mucosal protective barrier.[3] The main risk factors associated with clinically important haemorrhage are mechanical ventilation for >48 hours and the presence of a coagulopathy.

autoimmune disease

Autoimmune disorders associated with increased risk of autoimmune gastritis include thyroid disease, idiopathic adrenocortical insufficiency, vitiligo, type 1 diabetes mellitus, and hypoparathyroidism.[24]

weak

immunocompromise

Phlegmonous gastritis is associated with HIV infection and other immunocompromised states.[29] It may also result from an infected peritoneo-jugular venous shunt.[30]

North European or Scandinavian ancestry

Recognised risk factor for autoimmune gastritis and pernicious anaemia due to vitamin B₁₂ malabsorption.[10]

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