Gastritis

Helicobacter pylori Gastritis

H. pylori is the most common cause of gastritis in the world. In addition, given its association with peptic ulcer disease, atrophic gastritis, and adenocarcinoma and with the rare entity of gastric lymphoma, it is the most important. The majority of individuals with H. pylori gastritis are asymptomatic, unless they develop ulcer disease, adenocarcinoma, or lymphoma. The prevalence of H. pylorivaries widely between socioeconomic classes and countries.

Acute Infection

In infected adults and children H. pylori induces an acute neutrophilic infiltrate, followed by a chronic gastritis, which remains present for the duration of the infection. Acute infection has been studied in a number of individuals,some of whom infected themselves for study purposes. The acute infection may cause epigastric pain, nausea, vomiting, halitosis, and headache. An early consequence of acute infection appears to be increased gastric acid secretion followed by achlorhydria within a week or so, lasting for 6 weeks or more. The decrease in acid secretion seems to correlate with the timing and degree of inflammation of the gastric oxyntic mucosa.

Chronic Infection

Some studies have suggested that acute infection with H. pylori quite often clears spontaneously in children, although this does not appear to be the case in adults, in whom infection likely is lifelong if untreated. Most infected individuals develop a chronic, active, nonatrophic gastritis, which is typically asymptomatic.

Peptic Ulcer Disease

Peptic ulcers can be classified as primary, secondary, or due to hypersecretory states. Secondary ulcers are those occurring in the presence of systemic underlying disease, whereas in primary ulcer disease this is usually not present, and the cause is either H. pylori or idiopathic (true Hp-negative disease). Primary peptic ulcers are more often duodenal, whereas secondary ulcers are more often gastric, or may be both. In children, primary ulcers may be single, with a punched-out appearance and raised rolled edges, sometimes with satellite erosions; or they may be multiple and shallower. Most primary peptic ulcers in children occur between the ages of 8 and 17 (mean 11.5) years,. whereas secondary ulcer disease occurs at all ages, depending on the cause of the underlying gastritis. Ulcer disease due to hypersecretory states is more commonly duodenal.