Gastritis, erosive K29.1

As early as 1842, Thomas Blizzard Curling published the classic description of the acute (stress) ulcers following burns that were later named after him (Feifel 1980).

Erosive gastritis is a form of acute gastritis in which endoscopically visible epithelial hemorrhages and histologically erosions exist in the gastric mucosa (Kasper 2015).

Acute gastritis is subdivided into

- acute irritable gastritis

- erosive gastritis (Herold 2022)

Erosive gastritis is also known as "stress gastritis." It results primarily from a dysregulation in the production of gastric acid (Megha 2022).

Erosive gastritis occurs in about 50% of patients who regularly take NSAIDs, and in about 20% of active alcohol drinkers (Kasper 2015).

It is estimated that the number of those suffering from asymptomatic gastritis in critical illness is approximately > 75%, stress ulcers with occult bleeding occur in approximately 15-50%, manifest bleeding between 1.5-8.5%, and significant bleeding between 1-3%.

In 2002, Wuerth et al. reported an incidence of about 81 cases / 100,000. With the use of proton pump inhibitors (PPI) or histamine blockers, this number decreased by up to 55 % (Megha 2022).

Erosive gastritis is most commonly caused by:

- non-steroidal anti-inflammatory drugs (NSAIDs)

- alcohol

- Stress associated with e.g. major surgery, burns, severe trauma, severe intracranial disease, severe medical illness, etc. (Kasper 2015)

- Stress due to psychiatric stressors such as severe untreated depression (Megha 2022).

According to Yamamoto (2011), a proven risk factor for erosive gastritis is obesity, as there is a correlation between low adiponectin (adiponectin secretion is inversely related to body mass index [Gressner 2020]) and erosive gastritis - independent of BMI or H. pylori infection.

Physiological stress causes a release of angiotensin II. This causes a decrease in blood flow in the area of the gastric mucosa. This results in the formation of reactive oxygen species which attack the DNA and lead to the formation of 8-hydroxydesoxyguanosine. This results in oxidative stress for the mucosa (Megha 2022).

Increased ACH and histamine levels increase acid production and cause misregulation of gastric pH. This leads to the development of acute gastritis. Due to the acute gastritis, erosions can form in the area of the gastric mucosa, the so-called curling ulcers (Megha 2022).

- persistent nausea, vomiting

- pain in the epigastrium

- hematemesis

- melena

- Orthostasis in severe courses (Megha 2022).

Gastroscopy with appropriate biopsies is used in the 1st line for diagnosis, as well as fecal occult blood testing (FOBT) and Helicobacter pylori testing (Megha 2022).

Gastroscopy

In erosive gastritis, epithelial defects are found (Herold 2022); these are superficial and appear as erythematous lesions in the corpus and fundus (Megha 2022).

Serological tests

Serologic testing can detect antibodies to detect H. pylori infection. However, it is not possible to differentiate between an acute or chronic form of gastritis (Azer 2022).

Occult blood test (Megha 2022).

In erosive gastritis, the substance defect is limited to the lamina propria, in contrast to the substance defect in ulcer, which always involves the muscularis mucosa (Braun 2022).

When a curling ulcer occurs, inflammatory deposits with eschar are found. Below the base of the ulcer, there is neutrophilic infiltration and active granulation, mononuclear infiltration, and occasional fibrinoid necrosis (Siddiqui 2022).

- ventricular ulcer

- gastroesophageal reflux disease (GERD)

- carcinoma of the esophagus / stomach / pancreas

- gastroparesis

- biliary colic

- uremic gastropathy

- dyspepsia (Megha 2022)

- Hemorrhage (most frequent complication [Megha 2022])

- Ulcers (Herold 2022)

- Curling ulcers

- Perforation (the rarest complication at approximately 10% [Megha 2022]).

Proton pump inhibitors such as omeprazole (Lin 2021).

Dosage recommendation: omeprazole 40 mg / d (Weihrauch 2022).

Histamine blockers (H2- blockers) such as cimetidine are available as another therapeutic option (Megha 2022). Dosage recommendation: cimetidine 2 x 400 mg / d (Gerok 2007).

The prognosis is usually good. In exceptional cases, life-threatening bleeding may occur (Rosien 2023).

Erosive gastritis can often be prevented in polytrauma patients, major surgical procedures, myocardial infarction, etc. by early use of proton pump inhibitors such as omeprazole. The reduction in disease with early therapy is between 30-55% (Megha 2022).

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