SAVED
File name
.JPG
File alt. text
Image should be
px wide x
px tall.
Select Image
Select Image
L
O
G
I
N
EXISTING USERS
NEW USERS
password:
Forgotten your password?
password:
LOG IN
REGISTER
The Gastroenterology Training Handbook
For Specialist Registrars
HOME
OESOPHAGUS
•Gastro Oesophageal Reflux Disease
•Oesophageal Cancer
•Oesophageal Dysmotility
•Benign Oesophageal Lesions
•Miscellaneous
•Dysphagia
STOMACH
•Obesity Surgery
•Clinical Presentations of Gastric Conditions
•Gastric Cancer
•Gastric Polyps and Masses
•Peptic Ulcer Disease
•Gastritis and Gastropathy
•Miscellaneous
SMALL BOWEL
•Coeliac Disease
•Small Bowel Infections
•Small Bowel Masses
•Miscellaneous
COLON
•Colorectal and Anal Cancer
•Diagnostic Pathways for Colonic Disease
•Colonic Vascular Disorders
•Anal Diseases
•Various Colitides
•Colonic Motility Disorders
•Miscellaneous
•Colonic Infection
LIVER
•Alcohol
•Liver Failure
•Miscellaneous
•Ascites
•Bilirubin Metabolism
•Vascular Problems
•Clinical Presentations
•Liver Masses
•Hepatitis B
•Hepatitis C
•Autoimmune Conditions
•Metabolic Conditions
•Treatments
•Various Viruses
•Hepatopulmonary Disorders
•Liver Imaging
BILIARY
•Gallstone Disease
•Biliary Cancers
•Biliary Parasites
•Miscellaneous
NUTRITION
•Nutrition Therapy
•Minerals
•Proteins, Fats and Sugars
•Vitamins
•Clinical Conditions and Nutrition
PANCREAS
•Pancreatitis
•Pancreatic Masses and Cysts
•Pancreatic Cancers
•Other
IBD
•Epidemiology
•IBD Diagnosis
•Extra Intestinal Manifestations
•Surgery
•Treatment
MISCELLANEOUS
•Bleeding
•Rheumatological Disease
•Infection
•Vascular Lesions
•Other
home -
Stomach -
Gastritis and Gastropathy -
Gastritis Overview
search
Ask a question in the forum
Written by Dr Sebastian Zeki
MCQs for this page
Gastritis Overview
View large version
Embed image
paste this code into your webpage / blog to share.
Surveillance endoscopy
IM alone doesnt need surveillance
Family history or background
High grade dysplasia needs resection (local or gastrectomy)
Pernicious anaemia may need a single OGD to identify specific lesions but not routine
Metaplastic
(chronic) atrophic
gastritis
Autoimmune
Environmental
Types
Both have metaplasia as defining feature:
Types
Pseudopyloric metaplasia-
Replacement of parietal and chief cells in
oxyntic glands by mucus-secreting cells of
the type found in antral (ie, pyloric) mucosa
Type I
- Complete intestinali
-
sation
Types II and III
incomplete
intestinalisation (ie goblet
cells but no
Paneth
cells)
Autoimmune metaplastic
Atrophic gastritis
Immune response in the
oxyntic
mucosa directed against parietal cells
and intrinsic factor.
Associations:
HLA B-8 and DR-3
Pernicious anaemia and hypochlo
-
rhydria.
Autoimmune thyroid disease
Clinical features —
Autosomal dominant disorder that
commonly affects people of northern
Europe or northern European
extraction
M:F is 1:3
Pathology —
The proportion of pseudopyloric and
intestinal metaplasia within the body
and fundus vary widely among
patients, and either form can
predominate.
Gastric adenocarcinoma
In 1-3% AMAG
Highest risk 1 year after diagnosis of
pernicious anemia.
Get focal lymphocytic
infiltration including
epithelial lymphocyto
-
sis with destruction of
oxyntic glands.
Pseudohypertro
-
phy of parietal
cells resembling
that seen during
treatment with
omeprazole may
be present in the
islands of
surviving mucosa
Early stages(active autoimmune
gastritis):
The metaplasia, glandular atrophy, and inflammation are confined to the
gastric body and fundus
The gastric body and fundus may appear to contain multiple polyps
(=islands of normal tissue)
End-stage AMAG:
Lack of rugal folds
Visible blood vessels
Oxyntic glands replaced by metaplastic glands
Carcinoid
tumors
Macroscopi
-
cally:
Mucosal
nodules/polyps
ECL cell hyperplasia is
also observed in PPI
induced hypergastrinae
-
mia but not associated
with carcinoid
G-cells
hyperplasia
Gastrin
Trophic effect on
enterochromaffin-like cells
(ECL cells- usually produce
histamine), within the
metaplastic and atrophic
body mucosa.
Gastrin normal
Decreased gastric acid
production
Inflammation
M
e
t
a
p
l
a
s
i
a
A
t
r
o
p
h
y
Inflammation
M
e
t
a
p
l
a
s
i
a
A
t
r
o
p
h
y
Proximal migration of transitional
zone (between body and antrum)
with intestinalisation
Oxyntic mucosa (normal mucosa
in body and fundus) may become
atrophied and thin
Progression from IM to
Gastric Cancer Risk
Factors:
-Family history of
gastric cancer.
-Residence in or
migration from a high
risk location.
-Member of a high risk
ethnic population.
-Dysplasia on biopsy.
-Extensive IM on
biopsies (more
important then
metaplastic subtype)
Intestinal
metaplasia
Gastric
Cancer
Hypochlorhydria
Trophic Effect
Complications of AMAG
AMAG
EMAG
Metaplasia
Metaplastic
Gastritis
Gastric Cancer
Gastric ulceration
Focally distributed
areas in antrum
Risk factors
—
Nitroso compounds
( by bacterial
metabolism of nitrates).
Helicobacter pylori
—
Written by Dr Sebastian Zeki
Related Stories
•
•
•
•
•