Gastritis and gastropathy

Peptic ulcer disease is a mucosal break in the stomach or duodenum caused chiefly by Helicobacter pylori infection or NSAID use, diagnosed by upper endoscopy with biopsy of gastric ulcers to exclude malignancy. Treatment eradicates H. pylori when present, stops the ulcerogenic drug, and heals the ulcer with a proton pump inhibitor, while its complications of bleeding, perforation, and obstruction drive most of its morbidity.

Perforated peptic ulcer is a full-thickness gastric or duodenal defect that lets luminal contents leak into the peritoneal cavity, causing sudden severe epigastric pain and diffuse peritonitis. Diagnosis is confirmed by free intraperitoneal air on imaging. Treatment is resuscitation, broad-spectrum antibiotics, and emergency surgical repair, most often an omental patch.

GERD is retrograde reflux of gastric contents into the esophagus causing heartburn and regurgitation, diagnosed clinically and confirmed by response to an empiric PPI trial, with endoscopy reserved for alarm features or refractory symptoms. Management proceeds from lifestyle measures through an 8-week once-daily PPI trial, dose escalation or agent switch for partial response, and fundoplication for medication-refractory or regurgitation-predominant disease.

Dyspepsia is chronic or recurrent epigastric pain, burning, postprandial fullness, or early satiety that is organic when a structural, metabolic, or drug cause is found and functional when Rome IV criteria are met after a negative workup. Management starts with an alarm-feature screen that mandates prompt upper endoscopy, then test-and-treat for Helicobacter pylori, then an empiric proton pump inhibitor trial, reserving a tricyclic or prokinetic agent for confirmed functional disease.

Gastric cancer is mostly adenocarcinoma, split into an H. pylori-driven intestinal type arising through chronic atrophic gastritis and intestinal metaplasia and a diffuse signet-ring type causing linitis plastica, and it typically presents late with alarm dyspepsia and weight loss. Upper endoscopy with biopsy confirms the diagnosis, TNM stage with endoscopic ultrasound, CT, and diagnostic laparoscopy sets treatment, and management ranges from endoscopic resection for early T1a disease to gastrectomy with D2 lymphadenectomy and perioperative FLOT chemotherapy for resectable disease to palliative chemotherapy for advanced disease.

Pernicious anemia is autoimmune atrophic gastritis that destroys gastric parietal cells and abolishes intrinsic factor production, causing vitamin B12 malabsorption, megaloblastic macrocytic anemia, and a potentially irreversible myelopathy and neuropathy. Diagnosis rests on a low or borderline B12 with an elevated methylmalonic acid, confirmed by anti-intrinsic factor antibody, and treatment is lifelong vitamin B12 replacement.

Portal hypertension is elevated pressure in the portal venous system, most often from cirrhosis, that drives the major decompensating complications of chronic liver disease: varices, ascites, splenomegaly, and encephalopathy. Diagnosis rests on imaging and endoscopy for its downstream signs, and management combines treating the underlying cause with nonselective beta-blockade and, for refractory complications, TIPS.

Cirrhosis is end-stage hepatic fibrosis with regenerative nodules, staged as compensated or decompensated by the onset of ascites, variceal hemorrhage, encephalopathy, or jaundice. Severity is graded by Child-Pugh class and MELD, and management centers on treating the underlying cause, surveillance for varices and hepatocellular carcinoma, and timely transplant referral once decompensation appears.

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain, fever, and inflammation by inhibiting cyclooxygenase (COX)-1 and COX-2, and that single mechanism predicts every major toxicity: gastric ulceration, platelet dysfunction, and hemodynamic renal injury. First-line agents are naproxen or ibuprofen (or topical diclofenac for knee or hand osteoarthritis) at the lowest effective dose for the shortest duration, with a proton pump inhibitor such as omeprazole 20 mg once daily added for patients at increased gastrointestinal risk.

Mallory-Weiss syndrome is a partial-thickness, longitudinal mucosal tear at the gastroesophageal junction caused by forceful retching or vomiting, classically presenting as hematemesis after an initial bout of non-bloody vomiting in a patient with alcohol use disorder or bulimia. Upper endoscopy is both diagnostic and therapeutic, most tears stop bleeding spontaneously, and active bleeding is controlled endoscopically.

Celiac disease is an immune-mediated small-intestinal enteropathy triggered by dietary gluten in genetically predisposed individuals, presenting with malabsorptive diarrhea, iron-deficiency anemia, or dermatitis herpetiformis. Diagnosis requires IgA tissue transglutaminase serology with a total IgA level while the patient still eats gluten, confirmed by duodenal biopsy showing villous atrophy, and the only treatment is a strict lifelong gluten-free diet.

Gastroparesis is delayed gastric emptying without mechanical obstruction, most often from longstanding diabetes, prior gastric surgery, or an idiopathic postviral course, presenting with nausea, vomiting, early satiety, and postprandial fullness. Diagnosis requires upper endoscopy to exclude obstruction followed by objective gastric emptying testing, and management progresses from glycemic control and dietary change through time-limited prokinetics to device or endoscopic therapy for refractory disease.

Acute upper gastrointestinal bleeding arises proximal to the ligament of Treitz and presents with hematemesis or melena, most often from peptic ulcer disease or bleeding gastroesophageal varices. Management sequences resuscitation, restrictive transfusion, IV proton pump inhibitor therapy, and, when varices are suspected, octreotide plus antibiotic prophylaxis, all before upper endoscopy within 24 hours, which is both diagnostic and therapeutic.

Acute pancreatitis is acinar-cell autodigestion and inflammation of the pancreas, most often from gallstones or alcohol, diagnosed by the revised Atlanta criteria and graded mild, moderately severe, or severe by organ failure. Management centers on early goal-directed lactated Ringer's resuscitation, analgesia, early enteral feeding, and timed ERCP for gallstone pancreatitis with cholangitis, reserving antibiotics for confirmed infected necrosis.

Crohn disease is a chronic transmural inflammatory bowel disease that can affect any segment from mouth to anus in skip lesions, most classically the terminal ileum, and is confirmed by ileocolonoscopy showing cobblestoning, skip areas, and non-caseating granulomas on biopsy. Management follows an ordered sequence of glucocorticoid or budesonide induction followed by immunomodulator or biologic maintenance, with surgery reserved for fixed complications rather than cure.