Gastritis

Use “gastritis” when gastric biopsy shows mucosal inflammation. Apply “gastropathy” to erosive or hemorrhagic-appearing injury with minimal or no inflammation; this distinction matters because reactive injury shifts attention toward NSAIDs, alcohol, bile reflux, ischemic stress, and other chemical or hemodynamic exposures rather than infection or autoimmunity. BMJ+2BMJGastritis - Symptoms, diagnosis and treatment | BMJ Best Practice USBMJGastritis - Symptoms, diagnosis and treatment | BMJ Best PracticeScienceDirectAtrophic Gastritis - an overview

In an acute-care presentation, identify patients in whom mucosal injury may reflect stress-related ischemia rather than uncomplicated dyspepsia. Stress is a recognized cause of gastritis secondary to mucosal ischemia; pursue the underlying hemodynamic or critical-illness driver while arranging upper endoscopy when diagnostic or therapeutic evaluation is otherwise indicated. BMJ+1BMJGastritis - Symptoms, diagnosis and treatment | BMJ Best Practice USBMJGastritis - Symptoms, diagnosis and treatment | BMJ Best Practice

At the first evaluation, document current and recent NSAID exposure, alcohol use, prior H. pylori testing or treatment, antibiotics, proton-pump inhibitor use, and autoimmune history. H. pylori, NSAIDs, and alcohol are common causes; autoimmune gastritis and stress-associated mucosal ischemia are important alternative branches. BMJ+1BMJGastritis - Symptoms, diagnosis and treatment | BMJ Best Practice USBMJGastritis - Symptoms, diagnosis and treatment | BMJ Best Practice

When endoscopy is not otherwise necessary, use a urea breath test or stool antigen test to diagnose active H. pylori infection. Stool antigen detection represents active infection and can be used both for initial diagnosis and confirmation of successful eradication; urea breath testing likewise documents active infection. ScienceDirectScienceDirectUrea Breath Test - an overview

Before a negative urea breath or stool antigen result is accepted, review medication timing. Both tests have reduced sensitivity during acid-reduction therapy and after recent antibiotics; proton-pump inhibitor use within 2 weeks can interfere with urea breath testing. Bismuth can also complicate stool antigen testing. Oxford Academic+1Oxford AcademicSerology Is More Sensitive Than Urea Breath Test or Stool Antigen for the Initial Diagnosis of Helicobacter pylori Gastritis When Compared With Histopathology | American Journal of Clinical Pathology | Oxford AcademicScienceDirectUrea Breath Test - an overview

Do not use IgG serology to establish cure because it cannot distinguish current infection from prior exposure. Serology may retain sensitivity despite proton-pump inhibitor or antibiotic use, but assay performance varies by kit and patient factors, so a positive result requires clinical context and does not itself establish active infection. Oxford AcademicOxford AcademicSerology Is More Sensitive Than Urea Breath Test or Stool Antigen for the Initial Diagnosis of Helicobacter pylori Gastritis When Compared With Histopathology | American Journal of Clinical Pathology | Oxford Academic

If upper endoscopy is being performed for another indication, obtain gastric biopsies for histologic assessment and H. pylori evaluation. Histology is described as the diagnostic reference standard, but organism distribution can be patchy and noninvasive testing can be discordant with biopsy findings. Oxford Academic+1Oxford AcademicSerology Is More Sensitive Than Urea Breath Test or Stool Antigen for the Initial Diagnosis of Helicobacter pylori Gastritis When Compared With Histopathology | American Journal of Clinical Pathology | Oxford AcademicScienceDirectUrea Breath Test - an overview

Perform high-quality upper endoscopy when clinical evaluation requires mucosal diagnosis, when atrophy or intestinal metaplasia is suspected, or when visible lesions need characterization. For premalignant and malignant lesion detection, use high-definition white-light endoscopy with image enhancement, mucosal cleansing, adequate insufflation, deliberate visual inspection, and photodocumentation. ScienceDirectScienceDirectAGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review

For suspected gastric atrophy with or without intestinal metaplasia, obtain biopsies according to a systematic protocol such as the updated Sydney System. Obtain at least five samples, place antrum/incisura and corpus specimens in separately labeled jars, and separately biopsy every suspicious focal area. This permits histologic confirmation and staging rather than simply reporting nonspecific chronic gastritis. ScienceDirectScienceDirectAGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review

Use anatomic distribution to direct the differential. Diffuse fundic atrophy favors autoimmune gastritis due to immune-mediated destruction of oxyntic epithelium, whereas multifocal atrophic disease is a distinct entity and H. pylori is a major cause of chronic atrophic gastritis and intestinal metaplasia. ScienceDirect+1ScienceDirectAtrophic Gastritis - an overviewGastroenterologyAssociation Between Helicobacter pylori Eradication and Gastric ...

Treat atrophic gastritis as a histologic diagnosis requiring endoscopic and pathologic staging. Atrophic gastritis is a precursor state in the pathway to gastric cancer, and H. pylori-associated chronic inflammation may progress through atrophy and intestinal metaplasia. ScienceDirect+2ScienceDirectAtrophic Gastritis - an overviewGastroenterologyAssociation Between Helicobacter pylori Eradication and Gastric ...GastroenterologyHelicobacter pylori Update - Gastroenterology

Test all patients with atrophic gastritis for H. pylori and eradicate documented infection. Eradication is an essential component of management and an adjunct to endoscopic screening and surveillance for gastric-cancer prevention; eradication has also been associated with modification of the natural course of atrophic gastritis and intestinal metaplasia. acpjournals+1acpjournalsImprovement in Atrophic Gastritis and Intestinal Metaplasia in ...ScienceDirectAGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review

When biopsies show corpus/fundus-predominant atrophy suggesting autoimmune gastritis, actively evaluate the patient for concomitant autoimmune thyroid disease because this association is common. Maintain H. pylori assessment as a separate branch rather than assuming autoimmune histology excludes infection. ScienceDirect+1ScienceDirectAtrophic Gastritis - an overviewScienceDirectAGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review

Use surveillance selectively after staging rather than applying one interval to every patient with gastritis. The appropriate decision and interval depend on endoscopic and histologic risk stratification, including the extent and severity of atrophy or intestinal metaplasia and any focal lesions identified at high-quality endoscopy. ScienceDirectScienceDirectAGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review

For confirmed H. pylori gastritis, prescribe an eradication regimen consistent with the current H. pylori treatment guideline, then document cure using a stool antigen or urea breath test rather than serology. The cited evidence establishes active-infection testing and the need for eradication, but regimen selection should account for current guideline recommendations, prior antibiotic exposure, and local resistance patterns. BMJ+2BMJGastritis - Symptoms, diagnosis and treatment | BMJ Best Practice USBMJManagement of Helicobacter pylori infection—the Maastricht V ... - GutScienceDirectUrea Breath Test - an overview

For NSAID- or alcohol-associated injury, the immediate intervention is removal or modification of the causative exposure. If biopsies show little inflammation, classify the lesion as gastropathy rather than H. pylori or autoimmune gastritis and avoid treating a histologic inflammatory diagnosis that is not present. BMJ+2BMJGastritis - Symptoms, diagnosis and treatment | BMJ Best Practice USBMJGastritis - Symptoms, diagnosis and treatment | BMJ Best PracticeScienceDirectAtrophic Gastritis - an overview

For H. pylori-negative atrophic disease, complete the systematic biopsy assessment before assigning autoimmune gastritis or another atrophic subtype. Corpus-predominant oxyntic atrophy supports autoimmune disease; multifocal atrophy requires risk stratification and surveillance planning based on endoscopic and histologic stage. ScienceDirect+1ScienceDirectAtrophic Gastritis - an overviewScienceDirectAGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review

Escalate from noninvasive testing to endoscopy when mucosal staging, lesion-directed biopsy, or evaluation for premalignant or malignant pathology is needed. Once atrophy or metaplasia is found, high-quality endoscopy with mapping biopsies is the decision-enabling procedure. ScienceDirectScienceDirectAGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review