1. Windsor University School of Medicine, St. Kitts
Agenda
Femi Akinyele. Roll #:1476
Presented: March 3, 2015.
MD4 - Pathology II
Windsor University School of Medicine, St. Kitts

2. Causes and Risk Factors
Outline
Introduction: Gastritis Overview - “The Family Tree”
Causes and Risk Factors:
Acute Gastritis
Type-A Chronic Atrophic Gastritis
Type-B Chronic Atrophic Gastritis
Clinical Findings:
Treatment:
High Yield Points
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

3. Introduction - The Gastritis “Family Tree”
What is Gastritis?
“Gastritis” describes a group of conditions with one thing in common: Inflammation
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

4. Causes and Risk Factors: Acute Gastritis
Acute Gastritis Risk Factors:
NSAID use - Inhibits COX, prostaglandin-E2 synthesis, bicarbonate synthesis, resulting in increased acid secretion, decreased mucin synthesis and decreased vascular perfusion.
Alcohol, smoking (Uremia)
CNS injury (Cushing’s ulcers)
CMV and Candida in AIDS patients
Anisakis (worm associated with consumption of raw fish)
Acute gastritis with hyperaemic gastric mucosa
Source:
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

5. Causes and Risk Factors
Also seen with:
Chemotherapy
Systematic Infections:
Viral - Norovirus, Rotavirus, Adenovirus
Bacterial - Campylobacter, E.coli 0157, Salmonella, Shigella, S.aureus, B.cereus, C.perfringes.
Parasites - Cryptosporidium, E.histolytica, G.lamblia
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

6. Causes and Risk Factors
Severe stress:
Trauma
Burns
Surgery
Ischemia & shock
Suicide - especially when acids and alkalis are used.
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

7. Causes and Risk Factors
Mechanical trauma
Bile reflux following digital gastrectomy
Steroid use – causes phospholipase-C production and arachidonic metabolites which increase leukotrienes, which in turn result in inflammation of the stomach.
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

8. Causes and Risk Factors: Type A Chronic Atrophic Gastritis
5% of chronic gastritis cases.
Autoantibodies from lymphocytes destroy parietal cells within the body and fundus of the stomach.
Type A = Autoimmune
Women (Scandinavian)
Associated disorders:
Systemic Lupus Erythematous
Hashimoto’s Thyroiditis
Myasthenia Gravis
Lambert Eden Syndrome
Green Immunofluorescence demonstrating antibodies to parietal cells
Source:
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

9. Causes and Risk Factors: Type B Chronic Atrophic Gastritis
95% of chronic gastritis cases
Most common reason for a peptic ulcer
H.pylori attacks the Antrum of the stomach
Destruction of mucin-producing cells causing ulceration of the epithelium
Ulcer can lead to bleeding, perforation and in rare cases, death.
Carries a risk of malignancy - Adenocarcinoma & Lymphoma
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

10. Clinical Findings: Acute Gastritis
Patient will present with one or more of the following symptoms:
Hematemesis: vomiting blood
Melena: dark sticky faeces containing partially digested blood
Iron deficiency (possibly) - but seen more with Type-B Chronic Atrophic Gastritis which causes ulcers than Acute Gastritis which causes erosion.
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

11. Causes and Risk Factors
Damage is limited to the muscularis mucosa
Microscopic findings:
Neutrophils - key sign for acute inflammation!
Edema - caused by increased vascular permeability
Congestion - caused by vasodilation
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

12. Mucosal blood flow is reduced
Pathogenesis:
Acute inflammation causes breakdown of the muscularis mucosa, resulting in erosion.
Mucosal cells experience further insult from the gastric acid and enzymes
Mucosal blood flow is reduced
Source:
Source:
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

13. Morphological findings:
Gastric mucosa undergoes a neutrophilic invasion.
Edema
Hemorrhage
Changes in the composition of the mucosa as it regenerates
Gastric Mucosa with neutrophilic invasion
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

14. Clinical Findings: Type A Chronic Atrophic Gastritis
Recall: There is an autoimmune destruction of parietal cells resulting in a deficiency of:
Hydrochloric Acid
Intrinsic Factor - (required to absorb Vitamin B12).
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

15. Causes and Risk Factors
Patient may present with what appears to be a B12 deficiency (megaloblastic anemia).
You give standard treatment of B12 and Folate, but will find that your patient is not responding.
Since patient is unresponsive to therapy, this is case of Gastritis, which carries with it an increased risk of gastric adenocarcinoma
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

16. Clinical Findings: Type B Chronic Atrophic Gastritis
Recall: H.pylori association - tested for using a gastric biopsy of the anteropyloric region (gold standard).
2 common patterns of Type B chronic gastritis presentation:
Anteral-type - Carries a high risk of duodenal ulcer because of high acid production
Pangastritis pattern - Has an increased risk of adenocarcinoma
Note: Type B Chronic Atrophic Gastritis is associated a risk of adenocarcinoma and lymphoma (MALT)
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

17. Morphology:
Persistent lymphoid activation results in the formation of germinal centers
Discovery of goblet cells - indicative of intestinal metaplasia which can lead to adenocarcinoma
M: Mucosa; SM: Submucosa; germinal center
Arrow head: intestinal metaplasia in chronic gastritis. Arrows show goblet cells &
lymphocyte and plasma cell infiltration
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

18. Causes and Risk Factors
H. pylori is found in the mucus layer.
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

19. Treatment: Acute Gastritis
2 strategies for treatment:
Pharmacological:
Synthetic Prostaglandin E2 - Restores bicarbonate production in pancreas.
Proton pump inhibitors - stomach contents less likely to cause erosion.
Non-pharmacological:
i. Avoid irritant (i.e. NSAIDs, alcohol, etc)
ii. Quit smoking!
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

20. Treatment: Type A Chronic Atrophic Gastritis
Surveillance - Gastroscopies at regular intervals looking for any new lesions and other changes. If found, biopsy!
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

21. Treatment: Type B Chronic Atrophic Gastritis
Medications that neutralize stomach acids (antacids)
Medications that decrease the secretion of acid in the stomach:
H2 blockers
Proton pump inhibitors (“-prazole” drugs)
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

22. Causes and Risk Factors
“High Yield”
Acute gastritis - caused by the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and alcohol.
Acute gastritis is associated with neutrophilic invasion and erosion
Type A chronic gastritis is caused by autoantibodies against parietal cells.This destroys the glands that secrete HCl and intrinsic factor. Lack of intrinsic factor prevents the absorption of Vitamin B12, leading to pernicious anemia.
Type A chronic gastritis is associated with increased risk of gastric adenocarcinoma
Type B chronic gastritis is caused by the H.pylori bacteria. It is associated with ulceration and increased risk of adenocarcinoma AND lymphoma.
Type B chronic gastritis is associated ulceration and increased risk of adenocarcinoma and lymphoma
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”

23. Causes and Risk Factors
Sources
Rapid Review Pathology - Third Edition - Edward F. Goljian
The Internet Pathology Laboratory for Medical Education. Mercer University School of Medicine, Savannah
Gastrolab - The Gastrointestinal site:
Pathology Department: Taiwan Medical University jpg&slides=1; 4.jpg&slides=4
Outline
Introduction
Causes and Risk Factors
Clinical Findings
Treatment
“High Yield”