57. Acute and chronic gastritis

Page created on April 11, 2022. Not updated since.

Introduction and epidemiology

Gastritis is the inflammation of the stomach. There are many causes of gastritis, and some are very common. Atrophic gastritis is a common type, in which atrophy and later intestinal metaplasia of the gastric mucosa occurs. Gastritis may predispose to peptic ulcer disease and gastric cancer.

In some conditions commonly referred to as gastritis there is no inflammation, and so the term gastropathy is more appropriate.

As H. pylori is the most common cause of gastritis, also see topic 56.

Etiology and types

  • Acute haemorrhagic erosive gastropathy = erosive gastritis
    • NSAIDs
    • Alcohol
    • Smoking
    • Critical illness (sepsis, ICU, trauma)
    • Hypovolaemia
  • Atrophic gastritis
    • Autoimmune metaplastic atrophic gastritis (AMAG)
    • Environmental metaplastic atrophic gastritis (EMAG) = helicobacter pylori gastritis (see topic 56)
  • Reactive/regenerative gastropathy/gastritis = chemical gastritis
    • Chronic NSAID use
    • Alcoholism
    • Bile acid or pancreatic juice reflux
  • “D” gastritis
    • Viral, bacterial, yeast infection
    • Allergy
    • Granulomatous disease
    • +++

Acute haemorrhagic erosive gastropathy refers to the acute development of multiple haemorrhagic erosive lesions in the stomach. It occurs when the balance of aggressive and protective factors tips in favour of aggressive factors.

Autoimmune metaplastic atrophic gastritis is an autoimmune disorder caused by idiopathic autoantibodies against parietal cells or intrinsic factor leading to atrophic gastritis. It may lead to B12 deficiency, in which case it’s known as pernicious anaemia.

Reactive gastropathy is a chronic gastropathy caused by long-term exposure to chemicals which injure the mucosa.

Clinical features

Many cases of gastritis are asymptomatic. Typical symptoms include:

  • Dyspepsia (epigastric pain and discomfort in relation to food intake)
  • Early satiety
  • Bloating
  • Epigastric tenderness
  • Weight loss

Acute haemorrhagic erosive gastropathy can cause additional symptoms, like occult blood loss, heartburn, and haematemesis.

Diagnosis and evaluation

Gastritis is a histological diagnosis and therefore requires endoscopy with biopsy for proper diagnosis. However, H. pylori is the most common cause of gastritis and can be diagnosed without biopsy. If H. pylori has been ruled out, biopsy might be required.

The mucosa often looks normal macroscopically. The histological findings depend on the cause:

  • Atrophic gastritis – chronic inflammation, atrophy, and metaplasia
  • Acute haemorrhagic erosive gastropathy – erosions are present
  • Reactive gastropathy – foveolar and smooth muscle hypoplasia, congestion, oedema,


PPIs and other anti-acid drugs may be used for symptomatic relief. Specific treatment is aimed at avoiding risk factors and treating the underlying cause if present. AMAG requires regular parenteral vitamin B12 supplements to prevent deficiency.

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