ISSN 2398-2969      

Stomach: chronic hypertrophic gastritis

icanis
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Synonym(s): Antral pyloric hypertrophy, Hypertrophic pyloric gastropathy (HPG


Introduction

  • Uncommon.
  • Cause: possibly excessive hormonal trophic factors, eg gastrin → focal, localized, eg pylorus obstruction or diffuse thickening of gastric mucosa. Reaction to foreign body, gastrinoma.
  • Signs: vomiting of variable character with or without blood.
  • Diagnosis: gastroscopy and histopathology; laparotomy and histopathology. Often normal biopsies with endoscopy. Laprotomy to get submucosa/muscle in biopsy.
  • Treatment: treat underlying cause or symptomatic.
  • Prognosis: depends on finding and eliminating the underlying cause.

Pathogenesis

Etiology

  • Unknown.
  • Excess hormonal trophic factors, eg:
    • Gastrin, histamine or acetylcholine - chronic hypertrophic gastritis in Basenji may be associated hypergastrinemia.
    • Also recognized with gastrinomas (Zollinger-Ellison syndrome) (pancreatitis, cell neoplasia).
    • Systemic mast cell neoplasia Skin: mastocytoma may also predispose to hypertrophy.
  • Chronic irritation: either mechanical foreign body or inflammatory.
  • Immune-mediated.
  • Stress.
  • Idiopathic.

Specific

Pathophysiology

  • May present as:
    • Focal disease - pyloric obstruction.
    • Diffuse disease - fundus.
    • Polypoid - antrum.
  • Glandular submucosal and/or muscular hypertrophy due to chronic stimulation associated with foreign body, gastrin, histamine excesses.
  • Chronic proton pump blocker (omeprazole Omeprazole ) adminstration.
  • Hypertrophy of parietal, mucus and chief cells → damage to mucosal barrier → back diffusion of hydrochloric acid and pepsin → inflammation and superficial ulceration.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Leib M S et al (1993) Endoscopic diagnosis of chronic hypertrophic pyloric gastropathy in dogs. J Vet Int Med 7 (6), 335-341 PubMed.
  • Bellenger et al (1990) Chronic hypertrophic pyloric gastropathy in 14 dogs. Australian Vet J 67 (9), 317-320 PubMed.
  • Penninck D G, Nyland T G, Kerr L Y & Fisher E F (1990) Ultrasonographic evaluation of gastrointestinal diseases in small animals. Vet Radiol 31 (3), 134-141 VetMedResource.
  • Walter et al (1985) Chronic hypertrophic pyloric gastropathy as a cause of pyloric obstruction in the dog. JAVMA 186 (2), 157-161 PubMed.

Other sources of information

  • Simpson K W & Dykes N C (1997)Diagnosis and treatment of gastrinoma.Semin Vet Med Surg12,274-281.
  • Denovo R C (1989)Antral pyloric hypertrophy syndrome.In:Current Vet Therapy X. pp 918.

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