Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Gastropathy 619

■Idiopathic

➣Diffuse varioform (chronic erosive) gastritis

■Nonerosive gastritis

➣Healthy aging

➣Associated withH. pyloriinfection

➣Lymphocytic gastritis

➣Atrophic gastritis with or without pernicious anemia

➣Associated with peptic ulcer or gastric adenocarcinoma

■Specific Types of Gastritis

➣Hypertrophic gastropathy

Menetrier’s disease

Zollinger-Ellison syndrome

Multiple gastric polyps

Localized hypertrophic gastropathy

➣Infectious gastritis

Syphilis, tuberculosis, candidiasis, aspergillosis, histoplasmo-

sis, giardiasis, cryptosporidiosis, strongyloides, CMV

➣Other conditions associated with granulomas:

Crohn’s disease, Whipple’s disease, chronic granulomatous

disease, allergic granulomatosis, sarcoidosis

■Eosinophilic gastroenteritis

management

What to Do First

■Upper endoscopy with biopsy

General Measures

■Removal of offending agent: alcohol, NSAIDs, aspirin

■Blood and stool cultures in setting of infection

specific therapy

■Infectious gastritis

➣H. pyloriis nonpathogenic in most infected individuals

➣Treat forH. pyloriin the setting of suspected or confirmed peptic

ulcer disease, lymphoma, gastric cancer

➣Specific treatment if other infectious etiologies identified

■Lymphocytic gastritis

➣Cause is unknown

➣Exclude lymphoma or other forms of gastritis

➣Consider treatment with proton pump inhibitors, misoprostol,

or corticosteroid therapy