Internal Medicine

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

620 Gastropathy

■Esosinophilic gastritis

➣Corticosteroids

■NSAID-induced gastritis

➣May be asymptomatic

➣Treat with withdrawal of offending agent if possible

➣In patients at increased risk for ulcer formation or those who

could not withstand the development of an ulcer, prophylaxis

with PPIs or misoprostol

■Ethanol-induced injury

➣Poor correlation with symptoms

➣Resolves with alcohol abstention

➣In setting of portal hypertensive gastropathy, beta-blockers, TIPS

or liver transplantation if refractory to treatment

■Stress-related mucosal injury

➣Improve underlying condition

➣Prophylaxis with intravenous H2-blocker decreases bleeding rate

■Pernicious anemia

➣Monthly injections of vitamin B12

■Menetrier’s disease

➣Eradication ofH. pyloriif detected

➣No treatment if minimal symptoms and borderline low albumin

Consider proton pump inhibitor therapy, corticosteroids,

and/or octreotide when diarrhea present

➣Partial gastric resection if persistent symptoms and low albumin

Side Effects of Specific Treatments

■Prednisone

➣Side Effects: Adrenal insufficiency, psychosis, immunosuppres-

sion, peptic ulcer, osteoporosis, appetite change, mood swings,

hyperglycemia, hypertension

➣Contraindications

Absolute: Systemic fungal infection

Relative: Congestive heart failure, seizure disorder, diabetes,

hypertension, osteoporosis, impaired hepatic function

■Vitamin B12

➣Side Effects: Pruritus, diarrhea, urticaria, peripheral vascular

thrombosis

■Misoprostol

➣Side effects: Miscarriage, diarrhea, abdominal pain, nausea,

vomiting, headache, menstrual irregularities

➣Contraindications