Gastrit ve Duodenit
Özet
Gastrit ve duodenit, mide ve duodenum mukozasının inflamatuvar hasarı ile karakterize, klinik pratikte dispepsi, epigastrik ağrı, bulantı, erken doyma ve üst gastrointestinal kanama spektrumunda karşımıza çıkabilen yaygın klinik durumlardır. Etiyolojide Helicobacter pylori enfeksiyonu, nonsteroid antiinflamatuvar ilaç (NSAİİ) kullanımı, safra reflüsü, otoimmünite, alkol, stres ilişkili mukozal hasar ve daha nadir enfeksiyöz ya da sistemik nedenler yer alır. Bu hastalık grubunun klinik önemi, semptomların çoğu zaman nonspesifik olmasına karşın, peptik ülser hastalığı, gastrointestinal kanama, atrofik gastrit, intestinal metaplazi ve gastrik kanser riski gibi sonuçlarla ilişkili olabilmesinden kaynaklanır. Hasta bilgilendirmesinde temel mesajlar; gastrit ve duodenitin tek bir hastalık değil farklı nedenlere bağlı gelişebilen mukozal inflamasyon tabloları olduğu, her mide yakınmasının endoskopi gerektirmediği, H. pylori saptandığında eradikasyon tedavisinin önemli olduğu ve NSAİİ kullanımının hekim önerisi olmadan sürdürülmemesi gerektiğidir. Kilo kaybı, disfaji, persistan kusma, demir eksikliği anemisi, hematemez, melena, ileri yaşta yeni başlayan dispepsi ve ailede üst gastrointestinal kanser öyküsü gibi alarm bulguları daha ileri değerlendirme gerektirir. Bu bölümün amacı, gastrit ve duodenitin tanımı, sınıflaması, klinik değerlendirmesi, tanısal yaklaşımı, tedavi ilkeleri ve hasta iletişiminde kullanılabilecek standart bilgilendirme mesajlarını kanıta dayalı biçimde özetlemektir.
Gastritis and duodenitis are common clinical conditions characterized by inflammatory injury of the gastric and duodenal mucosa. In clinical practice, they may present across a spectrum that includes dyspepsia, epigastric pain, nausea, early satiety, and upper gastrointestinal bleeding. Their etiology includes Helicobacter pylori infection, use of nonsteroidal anti-inflammatory drugs (NSAIDs), bile reflux, autoimmunity, alcohol, stress-related mucosal injury, and, less commonly, infectious or systemic causes. The clinical significance of this group of disorders stems from the fact that, although symptoms are often nonspecific, they may be associated with outcomes such as peptic ulcer disease, gastrointestinal bleeding, atrophic gastritis, intestinal metaplasia, and an increased risk of gastric cancer. The key messages in patient education are that gastritis and duodenitis do not represent a single disease entity, but rather patterns of mucosal inflammation that may arise from different causes; that not every gastric complaint requires endoscopy; that eradication therapy is important when H. pylori is detected; and that NSAID use should not be continued without medical advice. Alarm symptoms such as weight loss, dysphagia, persistent vomiting, iron deficiency anemia, hematemesis, melena, new-onset dyspepsia at an advanced age, and a family history of upper gastrointestinal cancer warrant further evaluation. The aim of this chapter is to provide an evidence-based summary of the definition, classification, clinical evaluation, diagnostic approach, treatment principles, and standardized patient-communication messages that can be used in the management of gastritis and duodenitis.
Referanslar
Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353- 1367.
Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-1762.
Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. American Journal of Gastroenterology. 2017;112(7):988-1013.
Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022;162(4):1334-1342.
Correa P. Human gastric carcinogenesis: a multistep and multifactorial process–First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Re¬search. 1992;52(24):6735-6740.
Black CJ, Paine PA, Agrawal A, et al. British Society of Gastro-enterology guidelines on the management of functional dys¬pepsia. Gut. 2022;71(9):1697-1723.
Lanza FL, Chan FKL, Quigley EMM; Practice Parameters Committee of the American College of Gastroenterology. Gu¬idelines for prevention of NSAİİ-related ulcer complications. American Journal of Gastroenterology. 2009;104(3):728-738.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. American Journal of Surgical Pathology. 1996;20(10):1161- 1181.
Pennelli G, Grillo F, Galuppini F, et al. Gastritis: update on etiological features and histological practical approach. Pat¬hologica. 2020;112(3):153-165.
Ierardi E, Losurdo G, Iannone A, et al. Lymphocytic duode¬nitis or microscopic enteritis and gluten-related conditions: what needs to be explored? Annals of Gastroenterology. 2017;30(4):380-392.
Villanacci V, Ceppa P, Tavani E, et al. Coeliac disease: the histology report. Digestive and Liver Disease. 2011;43 Suppl 4:S385-S395.
Li Y, Choi H, Leung K, et al. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis. Lancet Gastroenterology and Hepatology. 2023;8(6):553-564.
Zamani M, Ebrahimtabar F, Zamani V, et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Alimentary Pharmacology & Therapeutics. 2018;47(7):868-876.
Ozaydin N, Turkyilmaz SA, Cali S. Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-Urea breath test. BMC Public Health. 2013;13:1215.
Borch K, Jönsson KA, Petersson F, et al. Prevalence of gastro-duodenitis and Helicobacter pylori infection in a general po¬pulation sample: relations to symptomatology and life-style. Digestive Diseases and Sciences. 2000;45(7):1322-1329.
Wallace JL. Prostaglandins, NSAİİs, and gastric mucosal pro¬tection: why doesn’t the stomach digest itself? Physiological Reviews. 2008;88(4):1547-1565.
Dixon MF. Pathophysiology of Helicobacter pylori infecti¬on. Scandinavian Journal of Gastroenterology Supplement. 1994;201:7-10.
Neumann WL, Coss E, Rugge M, Genta RM. Autoimmu¬ne atrophic gastritis–pathogenesis, pathology and mana¬gement. Nature Reviews Gastroenterology & Hepatology. 2013;10(9):529-541.
Scarpignato C, Lanas A, Blandizzi C, Lems WF, Hermann M, Hunt RH; International NSAİİ Consensus Group. Safe presc¬ribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis–an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC Me¬dicine. 2015;13:55.
Shaukat A, Wang A, Acosta RD, et al. The role of endoscopy in dyspepsia. Gastrointestinal Endoscopy. 2015;82(2):227-232.
Stanghellini V, Chan FKL, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-1392.
Jaroń K, Pietrzak A, Daniluk J, et al. Diagnostic and thera¬peutic recommendations on Helicobacter pylori infection. Recommendations of the Working Group of the Polish So¬ciety of Gastroenterology. Gastroenterology Review/Przegląd Gastroenterologiczny. 2023;18(3):225-248.
Chey WD, Howden CW, Moss SF, et al. ACG Clinical Gui¬deline: Treatment of Helicobacter pylori Infection. American Journal of Gastroenterology. 2024;119(9):1730-1753.
Pimentel-Nunes P, Libânio D, Marcos-Pinto R, et al. Mana¬gement of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbio¬ta Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019;51(4):365- 388.
Laine L, Barkun AN, Saltzman JR, et al. ACG Clinical Gui¬deline: Upper Gastrointestinal and Ulcer Bleeding. American Journal of Gastroenterology. 2021;116(5):899-917.
Vakil N. Prescribing proton pump inhibitors: is it time to pa¬use and rethink? Drugs. 2012;72(4):437-445.
