Acute Gastritis

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Acute gastritis can be caused by a variety of exogenous and endogenous agents (Table 3.11). More often than in chronic gastritis, endoscopy reveals signs that point to the correct diagnosis (Table 3.12; Fig. 3.78). The endoscopic features do not suggest a specific causative agent of the gastritis, however. The diagnosis of acute gastritis often relies on the clinical presentation (upper abdominal pain, anorexia, nausea, vomiting) plus the en-doscopic findings, with histology showing little or no evidence of cellular infiltrate. The main role of biopsy is to distinguish between the various specific forms of gastritis (due to Crohn disease, infection, etc.).

Table 3.11 Causes of acute gastritis

► Bacteria (e.g., Helicobacter pylori)

► Medications (NSAIDs)

► Intoxication (alcohol)

► Mechanical lesion (foreign body, nasogastric tube)

► Vasculopathies

► Idiopathic

Table 3.12 Endoscopically detectable features of acute gastritis

Table 3.12 Endoscopically detectable features of acute gastritis

Erythematous Streaking

Fig. 3.78 Endoscopic features of acute gastritis a Marked edematous swelling of the mu-

Fig. 3.78 Endoscopic features of acute gastritis a Marked edematous swelling of the mu-

Erythematous Mucosa Antrum
b Exudate
Swelling With Gastritis

c Erythema cosa

Duodenal Bulb Ulcer

d Erosions

Antral Erythema

e Hemorrhages c Erythema d Erosions e Hemorrhages

cosa

Endoscopic diagnostic criteria (Fig. 3.79)

► Mucosa may appear normal in some cases

- Finely granular, bumpy surface

- Prominent folds and prominent areae gastricae

- Glassy, boggy appearance of the mucosa

- Punctate, patchy, confluent deposits

- Gray or yellowish streaks extending toward the pylorus

- Punctate, mottled, confluent, or blotchy areas of erythema

- On normal or reddened mucosa

- Flat, sometimes slightly raised

- Often found in the antrum

- Caution: Redness alone is a very indefinite parameter.

- Shallow epithelial defect in the mucosa

- A few millimeters in diameter, sharply circumscribed; surrounding mucosa may be normal or erythematous

- Thin fibrin coating usually present, occasionally fresh blood

- Often found in the antrum, occasionally in the gastric body

- Very reliable endoscopic criterion for acute gastritis

- Solitary or multiple petechiae, patches, or streaks, may be confluent

- Red (fresh) or dark (hematinized)

- Very reliable endoscopic criterion for acute gastritis

Fig. 3.79 Criteria for acute gastritis a Streaks of erythema radiating toward the pylorus b Mottled pattern of erythema in the antrum c Erosions in the antrum

Fig. 3.79 Criteria for acute gastritis a Streaks of erythema radiating toward the pylorus

Erythematous Mucosa Antrum

b Mottled pattern of erythema in the antrum

Erythematous Mucosa Antrum

d-h Typical findings in acute gastritis d-h Typical findings in acute gastritis

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