Difference between revisions of "Gastritis, Chronic"
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| − | + | ==Description== | |
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Chronic gastritis is often characterised by persistent [[vomiting|vomiting]] of variable frequency and appearance. The underlying cause is unknown but chronic gastritis can be classified into one of four types according to its histological appearance. | Chronic gastritis is often characterised by persistent [[vomiting|vomiting]] of variable frequency and appearance. The underlying cause is unknown but chronic gastritis can be classified into one of four types according to its histological appearance. | ||
| − | 1) '''Lymphocytic-plasmacytic gastritis''' which may be an immune response to numerous antigens. [[Helicobacter|''Helicobacter felis'']] has been suggested as a cause for such a reaction in dogs and cats. | + | 1)'''Lymphocytic-plasmacytic gastritis''' which may be an immune response to numerous antigens. [[Helicobacter|''Helicobacter felis'']] has been suggested as a cause for such a reaction in dogs and cats. |
| − | 2) '''Eosinophilic gastritis''' which may result from an allergic reaction to food antigens. | + | 2)'''Eosinophilic gastritis''' which may result from an allergic reaction to food antigens. |
| − | 3) '''Atrophic gastritis''' which is thought to result from an immune reaction and/or chronic gastric inflammation. | + | 3)'''Atrophic gastritis''' which is thought to result from an immune reaction and/or chronic gastric inflammation. |
| − | 4) '''Granulomatous gastritis''' which may be caused by ''Ollulanus tricuspis'' in cats. | + | 4)'''Granulomatous gastritis''' which may be caused by ''Ollulanus tricuspis'' in cats. |
| − | Also occurs in pigs and cattle, usually following a parasitic infection. In pigs it is present in up to 30% of pig herds and is most often caused by Redworms (''[[Hyostrongylus rubidis]]''). It mostly affects sows, and in small numbers produce little pathology, but large numbers cause [[Thin Sow Syndrome|thin sow syndrome]]. In cattle [[Ostertagiasis| | + | Also occurs in pigs and cattle, usually following a parasitic infection. In pigs it is present in up to 30% of pig herds and is most often caused by Redworms (''[[Hyostrongylus rubidis]]'').It mostly affects sows, and in small numbers produce little pathology, but large numbers cause [[Thin Sow Syndrome|thin sow syndrome]]. In cattle [[Ostertagiasis|Ostertagiasis]] produces a condition similar to thin sow syndrome. |
==Signalment== | ==Signalment== | ||
Can affect dogs, cats, pigs and cattle. | Can affect dogs, cats, pigs and cattle. | ||
| + | ==Diagnosis== | ||
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===Clinical Signs=== | ===Clinical Signs=== | ||
Include anorexia, vomiting (frequency is very variable from once weekly to several times each day). May also present with haematemesis and emaciation with longstanding disease. Sometimes dehydration is also present. | Include anorexia, vomiting (frequency is very variable from once weekly to several times each day). May also present with haematemesis and emaciation with longstanding disease. Sometimes dehydration is also present. | ||
===Laboratory Tests=== | ===Laboratory Tests=== | ||
| − | Clinical pathology findings are not diagnostic | + | Clinical pathology findings are not diagnostic of chronic gastritis. |
| − | On Haematology and biochemistry | + | On Haematology and biochemistry an anaemia due to chronic blood loss may be present, hypoproteinaemia due to protein loss from the stomach, electrolyte imbalance due to electrolyte loss in the vomitus, peripheral [[Eosinophilia|eosinophilia]] may be present with eosinophilic gastritis. |
Assess for signs of renal and hepatic disease as potential systemic causes of persistent chronic vomiting. | Assess for signs of renal and hepatic disease as potential systemic causes of persistent chronic vomiting. | ||
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===General Approach=== | ===General Approach=== | ||
Removal of the underlying cause should be the aim. | Removal of the underlying cause should be the aim. | ||
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Elimination diet in cases where lesions are infiltrated with eosinophils, plasma cells or lymphocytes as determined via biopsy as this may reflect a hypersensitivity to dietary protein. This may include feeding a homemade or veterinary restricted-protein or hypoallergenic diet. | Elimination diet in cases where lesions are infiltrated with eosinophils, plasma cells or lymphocytes as determined via biopsy as this may reflect a hypersensitivity to dietary protein. This may include feeding a homemade or veterinary restricted-protein or hypoallergenic diet. | ||
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===Lymphocytic-plasmacytic gastritis=== | ===Lymphocytic-plasmacytic gastritis=== | ||
| − | May | + | May resond to dietary therapy alone. [[Gastroprotective Drugs|Gastroprotectants]] such as sucralfate and cimetidine may be beneficial. |
[[Steroids|Corticosteroids]] can be used in moderate-severe cases as a means of immunomodulation. | [[Steroids|Corticosteroids]] can be used in moderate-severe cases as a means of immunomodulation. | ||
Azathioprine may be used in conjunction with corticosteroids in cases that fail to respond to corticosteroids alone. The white cell count should be monitored from 2 weeks after the first dose and treatment should be stopped if the count falls to less than 4x10e9/L. | Azathioprine may be used in conjunction with corticosteroids in cases that fail to respond to corticosteroids alone. The white cell count should be monitored from 2 weeks after the first dose and treatment should be stopped if the count falls to less than 4x10e9/L. | ||
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===Atrophic gastritis=== | ===Atrophic gastritis=== | ||
Is more difficult to treat than lymphocytic-plasmacytic or eosinophilic gastritis, diets low in fat and fibre may help to control signs. | Is more difficult to treat than lymphocytic-plasmacytic or eosinophilic gastritis, diets low in fat and fibre may help to control signs. | ||
| − | Corticosteroids are thought to be beneficial as it is thought that the disease is immune-mediated. Gastroprotective | + | Corticosteroids are thought to be beneficial as it is thought that the disease is immune-mediated. Gastroprotective Drugs are advised. Additionally prokinetics may be used to empty the [[Forestomach - Anatomy & Physiology|stomach]]. |
===Granulomatous gastritis=== | ===Granulomatous gastritis=== | ||
| − | This is difficult to treat. It does not respond well to diet or | + | This is difficult to treat. It does not respond well to diet or Corticosteroid therapy. |
==Prognosis== | ==Prognosis== | ||
| − | Depends on the type of gastritis, | + | Depends on the type of gastritis, Lymphocytic-plasmacytic gastritis and Canine eosinophilic gastritis have a good prognosis with approprate therapy. Feline eosinophilic gastritis has a Poor prognosis. |
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==References== | ==References== | ||
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| − | [[Category: | + | |
| + | [[Category:Stomach_and_Abomasum_-_Inflammatory_Pathology]][[Category:Pig]][[Category:Cattle]] | ||
| + | [[Category:To_Do_-_Caz]] | ||
Revision as of 15:14, 11 August 2010
Description
Chronic gastritis is often characterised by persistent vomiting of variable frequency and appearance. The underlying cause is unknown but chronic gastritis can be classified into one of four types according to its histological appearance.
1)Lymphocytic-plasmacytic gastritis which may be an immune response to numerous antigens. Helicobacter felis has been suggested as a cause for such a reaction in dogs and cats.
2)Eosinophilic gastritis which may result from an allergic reaction to food antigens.
3)Atrophic gastritis which is thought to result from an immune reaction and/or chronic gastric inflammation.
4)Granulomatous gastritis which may be caused by Ollulanus tricuspis in cats.
Also occurs in pigs and cattle, usually following a parasitic infection. In pigs it is present in up to 30% of pig herds and is most often caused by Redworms (Hyostrongylus rubidis).It mostly affects sows, and in small numbers produce little pathology, but large numbers cause thin sow syndrome. In cattle Ostertagiasis produces a condition similar to thin sow syndrome.
Signalment
Can affect dogs, cats, pigs and cattle.
Diagnosis
Clinical Signs
Include anorexia, vomiting (frequency is very variable from once weekly to several times each day). May also present with haematemesis and emaciation with longstanding disease. Sometimes dehydration is also present.
Laboratory Tests
Clinical pathology findings are not diagnostic of chronic gastritis. On Haematology and biochemistry an anaemia due to chronic blood loss may be present, hypoproteinaemia due to protein loss from the stomach, electrolyte imbalance due to electrolyte loss in the vomitus, peripheral eosinophilia may be present with eosinophilic gastritis. Assess for signs of renal and hepatic disease as potential systemic causes of persistent chronic vomiting.
Radiography
Plain abdominal radiography is usually unremarkable. Contrast radiography may reveal thickening or irregularity of the gastric rugae.
Biopsy
Biopsy of the stomach followed by histological examination should always be performed and are required for a definitive diagnosis. They should be taken via endoscopy as this is less invasive than via surgery.
Endoscopy
Gastroscopy can be used to visualise the gastric mucosa. Varying degrees of hyperaemia, hypertrophy and haemorrhage may be evident. However, if no endoscopic lesions are visualised, chronic gastritis cannot be ruled out.
Treatment
General Approach
Removal of the underlying cause should be the aim. Elimination diet in cases where lesions are infiltrated with eosinophils, plasma cells or lymphocytes as determined via biopsy as this may reflect a hypersensitivity to dietary protein. This may include feeding a homemade or veterinary restricted-protein or hypoallergenic diet.
Lymphocytic-plasmacytic gastritis
May resond to dietary therapy alone. Gastroprotectants such as sucralfate and cimetidine may be beneficial. Corticosteroids can be used in moderate-severe cases as a means of immunomodulation. Azathioprine may be used in conjunction with corticosteroids in cases that fail to respond to corticosteroids alone. The white cell count should be monitored from 2 weeks after the first dose and treatment should be stopped if the count falls to less than 4x10e9/L.
Eosinophilic gastritis
A strict elimination diet is often successful, the addition of corticosteroid therapy may be required in cases that do not respond to dietary therapy alone. Azathioprine can be used in addition in those cases that fail to respond. Gastroprotective Drug administration should be routine.
Atrophic gastritis
Is more difficult to treat than lymphocytic-plasmacytic or eosinophilic gastritis, diets low in fat and fibre may help to control signs. Corticosteroids are thought to be beneficial as it is thought that the disease is immune-mediated. Gastroprotective Drugs are advised. Additionally prokinetics may be used to empty the stomach.
Granulomatous gastritis
This is difficult to treat. It does not respond well to diet or Corticosteroid therapy.
Prognosis
Depends on the type of gastritis, Lymphocytic-plasmacytic gastritis and Canine eosinophilic gastritis have a good prognosis with approprate therapy. Feline eosinophilic gastritis has a Poor prognosis.
References
Hall, E.J, Simpson, J.W. and Thomas, D. (2005) BSAVA Manual of Canine and Feline Gastroenterology (1st Edition) BSAVA
Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier