gastritis

Photomicrograph of a preparation of gastritis with Helicobacter pylori shown by means of hematoxylin-eosin staining

A gastritis (plural: gastritis; from Ancient Greek γαστήρ (gaster) stomach , expressing the inflammation suffix itis ), literally an inflammation of the stomach , generally referred to clinical usage a inflammatory disease of the mucous membrane of the stomach , so a gastritis . An outdated term is gastric catarrh .

Classification according to ICD-10
K29.-	Gastritis and duodenitis
ICD-10 online (WHO version 2019)

classification

Gastritis as an incidental finding in the FDG- PET / CT , which was carried out for a different question; Foci of inflammation show an increased sugar metabolism, which is shown here in orange.

According to the course of time

Depending on the course of the disease over time, a distinction is made between acute and chronic gastritis. All forms of acute gastritis can take on subacute stages or become chronic.

By cause

Based on the cause ( etiology ), different subtypes of gastritis are differentiated today:

Type A gastritis

The Type-A -Gastritis is an autoimmune disease , the pathogenesis is not fully understood and the autoantibodies the acid-producing parietal cells attack (parietal cells). It accounts for about 5% of gastritis. As a result of the loss of cells, the pH value in the stomach increases, which permanently stimulates gastrin production . Gastrin in turn stimulates the neuroendocrine ECL cells of the stomach and has a trophic effect . There is a hyperplasia of these cells. The increased amount of gastrin also promotes the development of micro carcinoids . As the destruction of the intrinsic factor- forming parietal cells can lead to a reduced absorption of vitamin B ₁₂ (cobalamin) in the ileum , a vitamin B ₁₂ deficiency can result ( pernicious anemia ).

Type B gastritis

The type-B -Gastritis is a bacterial infection based on the most part of the corkscrew-shaped Helicobacter pylori is caused (HP). With a share of 85%, it is the most common form of gastritis. After fecal-oral ingestion, the pathogen spreads from the stomach entrance towards the stomach exit. The bacterium causes chronic gastric ulcers and is held responsible for promoting and developing stomach cancer .

In the case of frequent gastric complaints, a gastroscopy (gastroscopy) with simultaneous duodenoscopy ( duodenoscopy ) is recommended. The bacterium can be diagnosed as the cause by means of a urease test on a tissue sample ( biopsy ) . For some time now there has also been a Helicobacter breath test, a convenient, non-invasive measurement method in which the infection with Helicobacter pylori can be detected via the breath with high accuracy . Further possibilities to detect the bacterium are the detection of HP antibodies in the serum and the detection of HP antigen in the stool. In the first instance, eradication therapy is performed with a triple combination of two antibiotics and a proton pump inhibitor (e.g. esomeprazole , omeprazole ).

Since this form of gastritis is mostly located in the area of the gastric outlet (antrum pyloricum), it is also known as antral gastritis.

Type C gastritis

The type C -Gastritis is a chemically -induced gastritis. She is z. B. triggered by components of the bile in bile reflux after partial resection of the stomach ( Billroth operation ) or hiatal hernia . Certain nonsteroidal anti-inflammatory drugs ( acetylsalicylic acid (aspirin), diclofenac (Voltaren) and ibuprofen ) inhibit cyclooxygenase-1 and thus the formation of prostaglandin E2 , which leads to a reduced production of the protective mucous layer. Even antibiotics can cause a type C gastritis. Type C gastritis make up about 10%.

Other possible causes are: Food poisoning e.g. B. from aflatoxins , excessive alcohol consumption, smoking, chemical burns from acids and alkalis. These factors also destroy the protective layer of mucus on the stomach lining, so that the stomach acid causes ulcers on the stomach wall.

In addition to the standard medical textbooks, two other forms are also described:

Type D gastritis

The Type-D -Gastritis summarizes various special shapes together. This includes gastritis caused by rare pathogens, Crohn's disease gastritis, and collagen gastritis. The development of gastritis after severe physical illnesses and accidents is also described in the specialist literature; For example the curling ulcer as a result of severe, extensive skin burns .

Type R gastritis

The Type-R -Gastritis arises due to frequent heartburn ( reflux ) and is a serious complication in the form of Barrett's esophagus entail.

According to endoscopic / histological criteria

On the basis of a gastroscopy (gastroscopy) and histological criteria when examining the gastric mucosa (obtained by an endoscopic biopsy), gastritis is divided into erythematous , exudative , erosive , hemorrhagic , granulomatous and atrophic gastritis.

Symptoms

In acute gastritis there is often abdominal pain , which manifests itself as a feeling of pressure in the epigastric region or as pain in the upper abdomen. (The symptoms of a "spoiled stomach" correspond to both acute gastritis and the consequences of an overeating meal). The abdominal pain that occurs can, however, under certain circumstances be misinterpreted and then not correctly diagnosed. Because the pain can also be felt behind the breastbone, there is an overlap with the symptoms of other diseases, e.g. B. of the heart. Typical are pains that get better after eating and then return with the old intensity. Other signs include tarry stools , vomiting blood, and anemia caused by bleeding from the diseased stomach lining . Nonspecific symptoms such as loss of appetite, nausea, dark watery diarrhea and vomiting can also accompany gastritis - especially the chronic form. It is noteworthy, however, that the endoscopic and, above all, the histopathological diagnosis of gastritis does not correlate particularly frequently with the clinical diagnosis of gastritis. However, the diagnosis must always be made on the basis of the symptoms and does not always lead to the need for treatment. Differentiating between these is a medical challenge and sometimes leads to misjudgments by patients and doctors.

Complications

Type A: gastric mucosal atrophy , pernicious anemia , gastric carcinoma
Type B: ulcers, v. a. of the duodenum (5%) and (1%) may occur in the stomach itself, the risk for the development of gastric cancer is increased (1: 3000), as can the occurrence of MALT lymphoma ( B-cell - lymphoma of mucosa associated lymphatic tissue ) come with a risk of 1 in 40,000. Chronic idiopathic hives and idiopathic thrombocytopenic purpura are also found in some cases . An etiologically inexplicable iron deficiency anemia may also be present.
Type C: In the foreground are gastric bleeding and ulcers.

therapy

Treatment for type A gastritis depends on the severity of the inflammation. There are preferably the formation of gastric acid blocking proton pump inhibitors , as well as acid neutralizing antacid and also acid blocking H ₂ - antihistamines ( ranitidine administered). A life-long substitution of vitamin B ₁₂ is often required. Regular gastroscopic controls are necessary to avoid the possibility of carcinomas .

The therapy of type B gastritis is the eradication of Helicobacter pylori described above . The triple therapy consisting of two antibiotics and a proton pump inhibitor is given for seven days, thereby achieving an eradication squote of over 90%. The best results are shown by the combination of clarithromycin , amoxicillin and proton pump inhibitor (French scheme). After six to eight weeks, the success of the therapy is checked using a gastroscopy or the HP breath test. A vaccine against Helicobacter pylori is under development .

In type C gastritis, it is important to eliminate the cause, i.e. to refrain from ingesting harmful substances . Here, too, the adjuvant use of acid blockers is indicated. If long-term therapy associated with the use of non-steroidal anti-inflammatory drugs cannot be avoided, special gastric protection with ranitidine or a proton pump inhibitor (e.g. omeprazole ) is urgently indicated.

distribution

A survey by the Robert Koch Institute from 2009 found a proportion of 20.5% of adults in Germany who, according to their own information, had already had a doctor diagnosed gastritis or duodenitis ( duodenitis ) (women 23.3%, men 17.5%) ). 4.1% were (also) affected in the last 12 months (5.2% of women and 3.0% of men). Under the age of 65, women were significantly more affected than men.

literature

Werner Böcker et al. (Ed.): Pathology . Elsevier, Urban & Fischer, 3rd edition, Munich a. a. 2004. ISBN 3-437-42381-9 .
Mediscript 2nd state examination, CD-ROMs. Elsevier, Urban & Fischer, Munich 2006. ISBN 978-3-437-43884-4 .
Eduard Burgis: Intensive course in general and special pharmacology . Elsevier, 3rd edition 2005. ISBN 3-437-42612-5 .
Gerd Herold and colleagues: Internal Medicine 2020. Self-published, Cologne 2020, ISBN 978-3-9814660-9-6 .
Jürgen F. Riemann , Wolfgang Fischbach, Peter R. Galle, Joachim Mössner: Gastroenterology in clinic and practice. The complete reference work for clinics and practices. Paperback 2010. ISBN 978-3-13-158361-1