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".....pyloriImmunologic (autoimmune) in association with pernicious anemiaToxic, as with alcoh.....
.....medical , health , ,treatment, disease,weight loss , heart , depression....."

Chronic gasstritis is defined as the attendance of chronic mucosal inflammatory changes leading current to mucosal atrophy and epithelial metaplasia usually in the nothingness of erosionsThe epithelial changes may become dysplastic and constitute a background for the development of carcinoma. In the western nature the prevalence of histologic changes indicative of chronic gastritis exceeds 50% in the later decades of life.

The major etiologic associations of chronic gastritis are as folows:

Chronic infection by H.pylori
Immunologic (autoimmune) in association with pernicious anemia
Toxic, as with alcohol ingestion and cigarette smoking Postsurgical, especially antrectomy with gastroenterostomy with reflux of bilious duodenal secretions
Motor and mechanical, including obstruction, bezoars (luminal concretions) and gastric atony.
Radiation
Granulomatous conditions
Miscellaneous-amyloidosis, graft-versus-host disease

Helicobacter pylori

By far the most important etiologic association is chronic infection by the bacillus H.pylori. Chronic gastritis is notable for distinct causal subgroups and for patterns of histologic alterations that divert in out of place parts of the world. H.pylori is extant in 90% of patients with chronic gastritis affecting the antrum. As evident in this and later discussions, this organism plays a critical role in several major gastric disease . Prevalence of infection amidst elders in Puerto Rico exceeds 80%. Colonization rates increase with age reaching 50% in asymptomatic American elders over 50 years of age. Most infected persons also have the associated gastritis but are asymptomatic. In this and other areas where infection in endemic the organism seems to be acquired in childhood and persists for decades. H.pylori is part of a genus of bacteria that have adapted to the ecologic niche provided by gastric mucus. Nevertheless, infected persons are at additional risk for the development of peptic ulcer disease and as one gastric cancer.

H.pylori is a nonsporing , curvilinear gram-negative rod perceptible approximately 3.5* 0.5ìm. Such strains frequently dub the vacA gene also, which codes for an 87-kD vacuolating cytotoxin. The specialized traits that allow H.pylori to flourish include the following:

Motility (via flagella) allowing it to swim through viscous mucus
Elaboration of urease, which produces ammonia from endogenous urea thereby buffering gastric acid in the immediate vicinity of the organism
Binging of H.pylori organisms to gastric epithelial cells via a bacterial adhesin; binding is enhanced with epithelial cells that bear the blood group O antigen

H.pylori strains that word the cagA gene are by force associated with duodenal ulcer; the function of the 120-140kD protein product is unknown. H.pylori appears to be capable of initiating and perpetuating a chronic aspect of gastric mucosal injury. These two proteins, along with bacterial lipopolysaccharide endotoxin and other protein products appear to act as proinflammatory substances. It results from the pervasiveness of autoantibodies to the gstric gland parietal cells and intrinsic factor including one against the acid-producing enzyme, H+,K+,ATPase. Patients with chronic gastritis and H.pylori usually improve when treatd with antimicrobial agents, and replapses are associated with reappearance of this organism.

Autoimmune gastritis

This form of gastritis accounting for at a low ebb than 10% of cases of chronic gastritis. In the most dour cases, construction of intrinsic factor is lost, leading to pernicious anemia. Gland dissolution and mucosal atrophy lead to perdition of acid production. Nausea, vomiting and upper abdominal discomfort may occur. This uncommon form of gastritis is seen in association with other autoimmune disorders, such as Hashimoto thyroiditis and Addison disease.

Clinical features

Chronic gastritis usually causes few symptoms. Because parietal cells are nevermore all out destroyed however , these patients do not develop achlohydria or pernicious anemia. Individuals with advanced gastritis from H.pylori or other ambient causes are perpetually hypochlorhydric, owing to parietal cell damage and atrophy of body-fundic mucosa. Most important is the relationship of chronic gastritis to the development of peptic ulcer and gastric carcinoma. Serum gastrin levels are usualy within the normal range or only modestly elevated. The long-term risk of gastric cancer in persons with autoimmune gastritis is 2 to 4 % which is considerably greater than the normal population. Most patients with a peptic ulcer, whether duodenal or gastric, have H.pylori infection.

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