Acute erosive gastritis - Disorders of the stomach

Acute erosive gastritis

Definition

Superficial ulcers and erosions of the gastric mucosa develop after major surgery, trauma or severe illness.

Aetiology

This pattern of gastritis is seen in patients with shock, severe illness. It may also be seen with the use of nonsteroidal anti-inflammatory drugs, steroids and heavy alcohol ingestion. H. pylori can cause an acute gastritis, which typically starts in the antrum and may extend to involve the entire gastric mucosa.

·        Curling’s ulcers are a form of stress ulcers occurring in patients following burns.

·        Cushing’s ulcers occur in patients with neurosurgical illness possibly due to the increased intracranial pressure causing an increased in vagal secretormotor stimulus.

Clinical features

Patients develop epigastric pain, burning in nature associated with vomiting and occasionally haematemesis and perforation.

Macroscopy/microscopy

The gastric mucosa appears hyperaemic with focal loss of superficial gastric epithelium (ulceration) and small erosions.

Investigations

Diagnosis may be confirmed by endoscopy with a urease (CLO) test for H. pylori.

Management

Identification and management of the underlying cause is required, specific interventions include the use of H2 antagonists and proton pump inhibitors.