• Inflammatory pathologies that are histologically characterized by acute or chronic inflammation and cause diffuse damage to the gastric mucosa are known as gastritis.
• Gastric mucosal destruction without inflammation is defined as gastropathy.
Acute Gastritis
• There is neutrophil-dominated infiltration in the gastric mucosa.
• Infection (most commonly H. pylori) may occur as a result of drugs, radiation, stress, corrosive substances, physical and surgical trauma.
• In general, infections are the most common cause of acute gastritis.
• Sudden onset of abdominal pain, nausea and vomiting, but most of them are not well recognized clinically.
• Acute gastritis does not increase the risk of gastric cancer.
• Erosive / hemorrhagic gastritis constitutes a significant part of acute gastritis.
Acute erosive (hemorrhagic) gastritis
• It is a type of gastritis that occurs as a result of deterioration of gastric mucosal integrity and loss of superficial tissue.
• Factors that play a role in its pathogenesis:
Decreased gastric mucosal blood flow
Decreased mucus secretion and bicarbonate
Increased acid and gastrin secretion
Increased H+ reabsorption
Decreased mucosal cell regeneration
Decreased local prostaglandin synthesis
• Etiology
- NSAID: It is the most common cause of acute erosive gastritis.
- Stress-related mucosal damage
Curling ulcer on burns; Mucosal lesions, defined as Cushing's ulcers, occur with CNS disease, trauma, and surgery.
Mechanical ventilation, coagulopathy, sepsis, and multiorgan failure may cause stress-related mucosal damage.
Stress-related erosions are most common in the fundus and corpus of the stomach.
PPI prophylaxis is recommended in high-risk patients.
- Alcohol-induced mucosal damage
Chronic Gastritis
• There is mononuclear cellular infiltration such as lymphocytes, plasma cells and macrophages in the gastric mucosa.
• The most common cause of chronic gastritis is H. pylori.
• Chronic gastritis can be topographically divided into type A (fundus and corpus dominant) and type B (antrum dominant). Type B is more common.
• While the role of H. pylori in the pathogenesis of type B gastritis is more prominent, type A gastritis is more associated with autoimmunity (pernicious anemia).
• Apart from antral gastritis, H. pylori can also cause superficial pangastritis or corpus-dominated atrophic gastritis.
MALToma from the background of H. pylori-associated superficial pangastritis; On the other hand, the probability of gastric ulcer and gastric cancer development increased on the basis of corpus-dominated atrophic gastritis.
Atrophic Gastritis
• It is characterized by the involvement of the lower layers of the mucosa and the destruction of the glandular epithelium and the reduction of gastric secretions.
• Chronic gastritis may cause atrophic gastritis in the future.
• Atrophic gastritis is a predisposing lesion for gastric cancer.
Atrophic gastritis --- Multifocal atrophic gastritis --- Gastric atrophy --- Intestinal metaplasia --- Dysplasia --- Gastric cancer
Lymphocytic gastritis:
Gastric epithelium is infiltrated with lymphocytes. It may be associated with gluten enteropathy (Celiac disease).
Graniolomatous gastritis
It can be seen in the course of granulomatous diseases such as sarcoidosis, Crohn's disease, tuberculosis and histoplasmosis.
Crohn's disease most commonly affects the duodenum, followed by the pylorus and antrum in the upper GIS.
Menetrier's disease (hypertrophic gastropathy)
Giant gastric folds in the stomach fundus and corpus (stomach like brain), protein loss, hypochlorhydria; It is a gastropathy characterized by foveolar hyperplasia, mucosal thickening and glandular atrophy on biopsy.
It can be confused with lymphoma and infiltrative carcinomas by appearance.
It is also a precancerous lesion in terms of gastric cancer.
Excessive secretion of TGF-alpha (binds to EGFR) plays a role in the pathogenesis.
The first choice in treatment is cetuximab, an EGFR monoconal antibody.
