Gastritis-IsfahanUniversityofMedicalSciences.ppt

Gastritis Peyman Adibi,MD. Definition The term gastritis is used to denote inflammation associated with mucosal injury Gastritis is mostly a histological term that needs biopsy to be confirmed Gastritis is usually due to infectious agents (such as Helicobacter pylori) and autoimmune and hypersensitivity reactions. Definition Epithelial cell damage and regeneration without associated inflammation is properly referred to as gastropathy.“ Gastropathy may be referred without histological evidence and just according to gross appearance in endoscopy or radiology Gastropathy is usually caused by irritants such as drugs (eg, nonsteroidal antiinflammatory agents and alcohol), bile reflux, hypovolemia, and chronic congestion. Gross–histologic correlation? Research evidence Among 98 patients with endoscopic mucosal changes attributed to gastritis, 27 percent had a normal endoscopic biopsy specimen; i.e. PPV of 73 percent or at least 1 in four false positive diagnosis Research evidence among 69 patients with a normal endoscopic appearance, 63 percent had histological evidence of gastritis. NPV equals to 27 percent Classification Acute vs. chronic Acute refers to short term inflammation Acute refering to neurophilic infiltrate Chronic referring to long standing forms Chronic referring to mononuclear cell infiltrate especially lymphocyte and maccrophages Anatomical site Non HP gastritis (ICD10) 1. Chemical gastritis (acute?chronic) Alcoholic gastritis Drug induced gastritis (e.g., NSAID) Reflux ( due to duodenal juice or bile) gastritis Other chemical gastritis 2. Radiation gastritis 3. Allergic gastritis 4. Autoimmune gastritis 5. Special forms of gastritis 6. Gastritis?NOS 7. Duodenitis CLASSIFICATION CLASSIFICATION Acute hemorrhagic erosive hemorrhagic and erosive lesions shortly after exposure of the gastric mucosa to various injurious substances or a substantial reduction in mucosal blood flow ACUTE GASTRITIS - MORPHOLOGY Acute hemorrh