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Stomach

Gastritis

Erosive (acute hemorrhagic) gastritis


Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 12 November 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Acute mucosal inflammatory process, usually transient (normal stomach has only rare inflammatory cells)
● Erosion: loss of superficial epithelium above muscularis mucosa, accompanied by hemorrhage
● Variable changes include acute inflammatory infiltrate, extrusion of fibrinopurulent exudate into lumen, mucosal sloughing, regenerative changes in nearby epithelium
● Severe erosive disease may cause acute GI bleeds
● Associated with heavy use of NSAIDs (non-steroidal anti-inflammatory drugs, including aspirin), excessive alcohol use, heavy smoking, cancer chemotherapy, bile reflux, uremia, systemic infections (Salmonella), severe stress (trauma, burns, surgery), ischemia and shock, acid/alkali ingestion as part of suicide attempts, gastric irradiation or freezing, mechanical trauma (nasogastric tube), distal gastrectomy
● Major cause of massive hematemesis in alcoholics
● Occurs in 25% taking daily aspirin for rheumatoid arthritis; 20% of these develop overt bleeding; may be fatal in up to 5%
● Severe disease may progress to acute gastric ulcers
● Treatment with proton pump inhibitors reduces severity of mucosal damage and facilitates healing

Symptoms
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● None; also pain, nausea and vomiting

Physiology
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● Mucosal damage due to increased acid secretion with back diffusion into mucosa, decreased bicarbonate buffer, reduced blood flow, disruption of mucous layer

Gross images
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Various images

Micro description
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● Mild: modest edema of lamina propria, vascular congestion, intact epithelium, scattered neutrophils, and hemorrhage in mucosa, erosions with more severe disease

Micro images
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Acute gastritis

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