Gastropathy/Chronic Gastritis

GASTROPATHY

Definition:

Etiologies:

Increased frequency with age; Approximately 60% of adults have histological evidence of nonspecific gastritis

In general, chronic dyspepsia » EGD with inspection and biopsy:

(See corresponding chapter of each topic for more detail)
Gastric Carcinoma » Surgery/Chemotherapy
Gastric Lymphoma » Chemo/Debulking surgery
Hypertrophic Folds
- Menetrier’s Disease » PPI, Prokinetics; Rarely surgery
- ZES » Fasting gastrin, gastric acid analysis, secretin stimulation test; Surgery for localized tumor; PPI/Chemo for metastatic disease
- Gastric pseudolymphoma » Normal variant (1%)
Specific Gastritis
- Eosinophilic gastritis » Corticosteroids
- Alkaline/Bile gastritis occurs with surgery (i.e. Billroth I or II) » Bile acid binders (cholestyramine), Bile analog (ursodiol), Prokinetics, Surgery (Roux-en-Y)
- Granulomatous gastritis » Crohn’s disease, Sarcoid, TB, Syphilis, Histoplasmosis, Parasites; Treat specifically
- Portal HTN gastropathy » If blood loss, then BB, Nitrates, PPI
- Collagenous gastritis » No known effective therapy
Nonspecific Gastritis
- Nonerosive gastritis: Type A, Type B; See Chronic Antral & Fundal Gastritis on page 35
- Erosive gastritis:
  - H. Pylori: treat appropriately
  - Crohn’s disease: treat appropriately
  - Idiopathic/?Allergic: Trial of acid suppression; If continued symptoms: trial of oral cromolyn or steroids