Gastritis



Gastritis


Michael P. Federle, MD, FACR





Key Facts


Terminology



  • Inflammation of gastric mucosa induced by group of disorders that differ clinically but share similar imaging features



    • Common etiologies include H. pylori, NSAIDs, alcohol and coffee, stress


Imaging



  • Erosive gastritis, complete or varioliform erosions (most common type)


  • Erosions surrounded by radiolucent halos of edematous, elevated mucosa


  • Scalloped or nodular antral folds


  • Crenulation or irregularity of lesser curvature


  • Location: Gastric antrum on crests of rugal folds


  • Prolapse of antral mucosa through pylorus


  • Lack of complete distensibility of stomach (especially antrum)


  • CT: Decreased wall attenuation (edema or inflammation)



    • Close to water density


  • Upper GI series best for mucosal detail



    • CT for global view and concern for extragastric complications (e.g., perforation)


Top Differential Diagnoses



  • Gastric carcinoma


  • Zollinger-Ellison syndrome


  • Acute pancreatitis


  • Gastric metastases and lymphoma


Diagnostic Checklist



  • CT and upper GI usually suggest only gastritis



    • Specific etiology determined by other medical data ± endoscopic biopsy






(Left) Graphic shows an ulcer crater and numerous mucosal erosions, mostly in the antrum along the “ridges” of hypertrophied folds. The antrum is less than completely distensible. (Right) Upper GI series shows rows of varioliform erosions image along the tops of hypertrophied gastric antral folds. This is diagnostic of gastritis but not specific as to the etiology.






(Left) 30-year-old athletic woman with severe abdominal pain and nausea, due to NSAID gastritis. CT shows massive thickening of the gastric wall with marked edema of the submucosa image. The enhancing mucosa imparts a striped appearance to the gastric wall. (Right) In the same patient, the body and antrum are similarly involved image. Following cessation of ibuprofen use and beginning antacid therapy, the patient’s symptoms resolved and a repeat CT scan (not shown) was normal.



TERMINOLOGY


Definitions



  • Inflammation of gastric mucosa induced by group of disorders that differs in etiological, clinical, histological, and radiological findings


  • Classification of gastritis



    • Erosive or hemorrhagic gastritis (2 types)



      • Complete or varioliform


      • Incomplete or “flat”


    • Antral gastritis


    • H. pylori gastritis


    • Hypertrophic gastritis


    • Atrophic gastritis (2 types: A and B)


    • Granulomatous gastritis (Crohn disease and tuberculosis)


    • Eosinophilic gastritis


    • Emphysematous gastritis


    • Caustic ingestion gastritis


    • Radiation gastritis


    • AIDS-related gastritis: Viral, fungal, protozoal, and parasitic infections


IMAGING


General Features



  • Best diagnostic clue



    • Superficial ulcers and thickened folds


Upper GI Findings



  • Erosive gastritis, complete or varioliform erosions (most common type)



    • Location: Gastric antrum on crests of rugal folds


    • Multiple punctate or slit-like collections of barium


    • Erosions surrounded by radiolucent halos of edematous, elevated mucosa


    • Scalloped or nodular antral folds


    • Epithelial nodules or polyps (chronic)


  • Erosive gastritis, incomplete or “flat” erosions



    • No surrounding edematous mucosa


  • Nonsteroidal antiinflammatory drugs (NSAID)-induced



    • Linear or serpiginous erosions clustered in body, on or near greater curvature


    • Varioliform or linear erosions in antrum


    • NSAID-related gastropathy: Subtle flattening and deformity of greater curvature of antrum


  • Antral gastritis



    • Thickened folds, spasm or decreased distensibility


    • Scalloped or lobulated folds oriented longitudinally or transverse folds


    • Crenulation or irregularity of lesser curvature


    • Prolapse of antral mucosa through pylorus


  • H. pylori gastritis



    • Location: Antrum, body, or occasionally fundus; diffuse or localized


    • Thickened, lobulated gastric folds


    • Enlarged areae gastricae (≥ 3 mm in diameter)


  • Hypertrophic gastritis



    • Location: Fundus and body


    • Markedly thickened, lobulated gastric folds


  • Atrophic gastritis

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Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Gastritis

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