IntroductionBackgroundGastritis includes a myriad of disorders that involve inflammatory changes in the gastric mucosa， including erosive gastritis caused by Helicobacter pylori bacterial infections， other infectious gastritises， nonsteroidal anti-inflammatory drugs (NSAIDs)， noxious irritants， reflux gastritis from exposure to bile and pancreatic fluids， infectious gastritis， and gastric mucosal Peptic ulcer disease (PUD) refers to a discrete mucosal defect in the portions of the gastrointestinal tract (gastric or duodenal) exposed to acid and pepsin Presentations of gastritis and PUD usually are indistinguishable in the ED， and thus the ED management is generally the Emergent complications include hemorrhagic shock and peritonitis secondary to a perforated The clinician should be concerned about other life-threatening conditions (eg， acute coronary syndromes and aortic aneurysms)， which can mimic the presentation of For more information， see Medscape's Peptic Ulcer Disease Resource CPathophysiologyThe mechanisms of mucosal injury in gastritis and PUD are thought to be mainly caused by H pylori infections， coupled an imbalance of aggressive factors， such as acid production or pepsin， and defensive factors， such as mucus production， bicarbonate， and blood Erosive gastritis usually is associated with serious illness or with various Stress， ethanol， bile， and nonsteroidal anti-inflammatory drugs (NSAIDs) disrupt the gastric mucosal barrier， making it vulnerable to normal gastric Infection with H pylori， a short， spiral-shaped， microaerophilic gram-negative bacillus， is the leading cause of PUD and is associated with virtually all ulcers not induced by NSAID H pylori colonize the deep layers of the mucosal gel that coats the gastric mucosa and presumably disrupts its protective H pylori is thought to infect virtually all patients with chronic active Eradication of H pylori was thought to be the pathway to curing ulcer disease， but that has proven increasingly NSAIDs and aspirin also interfere with the protective mucus layer by inhibiting mucosal cyclooxygenase activity， reducing levels of mucosal Many people with known H pylori colonization or who are taking NSAIDs do not suffer from gastritis or PUD， which indicates other important causative factors must be FrequencyUnited StatesApproximately 10% of Americans eventually develop PUD， and about 10% of patients presenting to the ED with abdominal pain are diagnosed with PUD Prevalence has decreased in the United States over the last 30 InternationalFrequency of PUD is decreasing in the developed world but increasing in developing Mortality/MorbidityComplications of gastritis include PUD and， rarely， extensive PUD accounts for more than 50% of all causes of upper gastrointestinal bleeds in the United SComplications of peptic ulcer disease include bleeding， occasionally massive， and perforation leading to peritonitis and sepsis (rare)The mortality rate is SexMale-to-female ratio of gastritis is approximately 1:1Male-to-female ratio of PUD is approximately 2:1AgeAn estimated 60% of Americans older than 60 years harbor H Duodenal ulcers usually occur in those aged 25-75 Gastric ulcer prevalence peaks in those aged 55-65 ClinicalHistoryPatients typically present with abdominal pain that has the following characteristics:Epigastric to left upper quadrantFrequently described as burningMay radiate to the backUsually occurs 1-5 hours after mealsMay be relieved by food， antacids (duodenal)， or vomiting (gastric)Typically follows a daily pattern specific to patientNSAID-induced gastritis or ulcers are usually Sudden onset of symptoms may indicate Gastritis may present as bleeding， which is more likely in elderly Symptoms consistent with anemia (eg， fatigue， dyspnea) may PhysicalEpigastric tenderness is present and usually Bowel sounds are Signs of peritonitis or GI bleeding may be Perform a rectal examination and Hemoccult CausesH pylori (most common cause of ulceration)NSAIDs， aspirinGastrinoma (Zollinger-Ellison syndrome)Severe stress (eg， trauma， burns)， Curling ulcersAlcoholBile refluxPancreatic enzyme refluxRadiationStaphylococcus aureus exotoxinBacterial or viral infection
