GastritisMANAGEMENT

GASTROINTESTINAL PRESENTATIONS · 12 SECTIONS

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565 items

☷ Legend

01Approach to the Critical Patient/attcp55

Stabilization priorities

›Immediate threats screen

›Airway risk

›Active hematemesis

›Altered mental status

›Shock physiology

›SBP <90 mm Hg

›Lactate elevation

›Peritonitis

›Rigid abdomen

›Rebound tenderness

›Monitoring and access

›Continuous monitoring

›Cardiac monitor

›Pulse oximetry

›IV access

›Two large bore peripheral IV lines for bleeding concern

›Intraosseous access if failed IV access

›Early escalation triggers

›GI bleeding pathway

›Hematemesis

›Melena

›Surgical abdomen pathway

›Free air on imaging

›Sepsis concern

Initial bedside differentiation

›Phenotype grouping

›Dyspepsia without bleeding

›Epigastric burning pain

›Early satiety

›Suspected upper GI bleed

›Coffee ground emesis

›Syncope or presyncope

›Complication concern

›Persistent vomiting

›Fever

›Time critical exclusions

›Cardiac ischemia

›Epigastric pain with diaphoresis

›Exertional component

›Perforated viscus

›Sudden severe pain

›Peritoneal signs

Key decision points

›Need for resuscitation bay

›Hemodynamic instability

›Tachycardia with hypotension

›Ongoing hematemesis

›Airway protection need

›Massive hematemesis

›Inability to protect airway

›Need for urgent endoscopy pathway

›Suspected upper GI bleed

›High risk features

›Anticoagulation use

›Persistent bleeding

›Hemoglobin drop

›Ongoing melena

02History/hx55

Symptom pattern and severity

›Symptom characterization

›Epigastric pain

›Burning or gnawing quality

›Relation to meals

›Nausea and vomiting

›Frequency

›Inability to tolerate oral intake

›GI bleeding symptoms

›Hematemesis

›Melena

›Time course

›Onset and duration

›Sudden onset

›Progressive course

›Prior episodes

›Similar dyspepsia history

›Prior ulcer disease

Exposure and risk profile

›Medication exposures

›NSAID exposure

›Dose and duration

›Concomitant steroids

›Antithrombotics

›Anticoagulants

›Antiplatelets

›Infection risks

›Helicobacter pylori risk

›Prior positive test

›Household exposure

›Recent gastroenteritis

›Sick contacts

›Foodborne exposure

›Substance exposures

›Alcohol use

›Heavy episodic use

›Recent binge

›Cannabis use

›Cyclic vomiting pattern

›Symptom relief with hot showers

Alarm features and red flags

›Alarm features

›Weight loss

›Unintentional

›Progressive

›Dysphagia

›Progressive solids to liquids

›Odynophagia

›Anemia symptoms

›Fatigue

›Dyspnea on exertion

›Cancer risk context

›Age 60 years or older with new dyspepsia

›Early endoscopy consideration

›Lower threshold with family history

›Family history

›Gastric cancer

›Upper GI malignancy

03Physical Exam/exam46

Vital signs and perfusion

›Hemodynamic status

›Blood pressure trends

›Orthostatic vitals for occult volume loss

›SBP <90 mm Hg as high risk

›Heart rate

›Tachycardia as volume loss marker

›Beta blocker masking risk

›Perfusion and shock markers

›Mental status

›Confusion

›Syncope

›Skin findings

›Cool extremities

›Delayed capillary refill

Abdominal and GI focused findings

›Abdominal exam

›Epigastric tenderness

›Localized tenderness

›Guarding

›Peritoneal signs

›Rebound tenderness

›Rigidity

›GI bleeding indicators

›Stool appearance

›Melena

›Hematochezia with brisk upper source concern

›Emesis appearance

›Coffee ground

›Bright red blood

›Extra abdominal clues

›Chest exam

›Rales for aspiration risk after vomiting

›Chest wall tenderness mimics

›Cardiac exam

›New murmur

›Irregular rhythm

PITFALLS

›Missed alternate diagnosis risk

›Epigastric pain as ACS equivalent

›Normal abdominal exam

›Risk factors for coronary disease

›Pancreatitis without classic radiation

›Alcohol use

›Hypertriglyceridemia history

›Underestimation of bleeding severity

›Normal initial hemoglobin

›Early bleeding before equilibration

›Hemoconcentration from dehydration

04Differential Diagnosis/ddx34

Life threatening and time sensitive

›High risk etiologies

›Upper GI bleed from peptic ulcer disease

›ICD-10 K27.0 to K27.9

›Hematemesis or melena

›Perforated ulcer or perforated viscus

›ICD-10 K25.1 to K28.1

›Sudden pain with peritonitis

›Acute coronary syndrome

›ICD-10 I21.0 to I21.9

›Epigastric pain with diaphoresis

Common mimics and related GI disorders

›Gastric and esophageal

›Gastritis

›ICD-10 K29.0 to K29.7

›SNOMED CT gastritis concept

›Gastroesophageal reflux disease

›ICD-10 K21.9

›Postprandial burning

›Esophagitis

›ICD-10 K20.9

›Odynophagia

›Hepatobiliary and pancreatic

›Acute pancreatitis

›ICD-10 K85.9

›Lipase elevation

›Biliary colic or cholecystitis

›ICD-10 K80.5 and K81.9

›RUQ pain and fatty food trigger

›Other

›Gastroenteritis

›ICD-10 A09

›Diarrhea predominant

›Mesenteric ischemia

›ICD-10 K55.9

›Pain out of proportion

05Laboratory Tests/lt45

Baseline evaluation set

›Core labs

›Complete blood count for bleeding or infection concern

›Hemoglobin trend for occult bleed

›Leukocytosis for complication concern

›Electrolytes and renal function for dehydration and dosing

›Potassium for vomiting related losses

›Creatinine for contrast planning

›Liver enzymes and bilirubin for hepatobiliary mimic

›Cholestatic pattern

›Hepatocellular pattern

›Targeted labs

›Lipase for pancreatitis mimic

›Elevation supports pancreatitis

›Normal does not exclude early pancreatitis

›Pregnancy test for reproductive age

›Ectopic mimic

›Medication safety planning

Bleeding and severe illness adjuncts

›Bleeding workup

›Type and screen for suspected GI bleed

›Crossmatch for ongoing bleeding

›Massive transfusion readiness

›Coagulation studies for anticoagulant use or liver disease

›INR interpretation

›Platelet count integration

›Shock and sepsis adjuncts

›Lactate for hypoperfusion concern

›Elevated lactate as high risk feature

›Trend after resuscitation

›Venous blood gas for acid base status

›Metabolic acidosis with severe illness

›Hypercapnia if respiratory compromise

Helicobacter pylori testing considerations

›Noninvasive testing

›Urea breath test for outpatient evaluation

›False negative risk with PPI use

›False negative risk with recent antibiotics

›Stool antigen test for outpatient evaluation

›Useful for test of cure

›False negative risk with bismuth use

›Test of cure timing

›At least 4 weeks after antibiotics

›Avoid premature testing

›Persistence risk if tested early

›At least 2 weeks after stopping PPI

›Avoid suppressed bacterial load false negative

›H2 blocker bridge option

06Diagnostic Tests/dt66

Scoring Systems

›Risk stratification for suspected upper GI bleed

›Glasgow Blatchford score

›Score 0 to 1 as very low risk

›Outpatient management consideration if stable

›Pre endoscopic Rockall score

›Age component

›Shock component

›Dyspepsia pathway thresholds

›Age 60 years or older with new dyspepsia

›Endoscopy to exclude organic pathology

›Lower threshold with cancer risk factors

›Alarm features

›Individualized endoscopy decision in younger patients

›Shared decision making for low pretest risk

MRI

›Limited routine role

›Alternative imaging when CT contraindicated

›Severe iodinated contrast allergy

›Pregnancy with complication concern and stable patient

›Complication evaluation adjunct

›Penetrating ulcer complication consideration

›Unclear mass evaluation pathway

›Indications for CT abdomen pelvis

›Peritoneal signs

›Perforation evaluation

›Surgical consultation linkage

›Severe pain with systemic signs

›Abscess or phlegmon evaluation

›Alternate diagnosis search

›Key CT findings

›Gastric wall thickening

›Nonspecific gastritis compatible finding

›Malignancy mimic awareness

›Free intraperitoneal air

›Perforation indicator

›Emergent surgical pathway

›Perigastric fat stranding

›Inflammatory change

›Complication context

Ultrasound

›Biliary evaluation

›RUQ ultrasound for RUQ pain or cholestatic labs

›Gallstones

›Gallbladder wall thickening

›Common bile duct dilation

›Choledocholithiasis concern

›Further imaging pathway

›POCUS adjuncts

›Aorta screening in older patient with abdominal pain

›AAA exclusion support

›Hemodynamic collapse differential

›Free fluid assessment in shock

›Intraperitoneal fluid detection

›Alternative source search

Endoscopy

›Upper endoscopy indications

›Suspected upper GI bleed

›Hematemesis or melena

›High risk score

›New dyspepsia age 60 years or older

›Organic pathology exclusion

›Biopsy for H pylori as needed

›Endoscopy timing concepts

›Suspected bleeding with stability

›Within 24 hours pathway

›Resuscitation first priority

›Persistent instability

›After stabilization and airway protection

›ICU level care coordination

07Disposition/dispo31

Discharge criteria and follow up

›Outpatient management suitability

›Hemodynamic stability

›No orthostatic symptoms after fluids

›Normal perfusion markers

›No active bleeding features

›No hematemesis in ED

›No melena with instability

›Oral intake tolerance

›Able to hydrate

›Controlled nausea

›Follow up plan

›Primary care or GI follow up

›Symptom reassessment in 2 to 4 weeks

›Earlier review if persistent symptoms

›H pylori testing plan when appropriate

›Test and treat strategy for dyspepsia without alarm features

›Test of cure after eradication therapy

Admission and higher level care

›Admission indications

›Suspected upper GI bleed

›Hemodynamic instability

›Hemoglobin drop

›Complication concern

›Peritonitis

›Sepsis physiology

›ICU indications

›Ongoing hemodynamic instability

›Vasopressor requirement

›Persistent tachycardia with hypotension

›Massive hematemesis

›Airway protection need

›High transfusion requirement

08Treatment/t90

Immediate symptom control

›Supportive care

›Oral rehydration for mild dehydration

›Clear fluids

›Small frequent sips

›IV crystalloid for moderate to severe dehydration

›Reassessment after bolus

›Electrolyte recheck based on losses

›Antiemetics

›Ondansetron

›4 mg PO or IV

›Repeat 4 mg every 6 to 8 hours as needed

›Metoclopramide

›10 mg PO or IV

›Avoid in bowel obstruction concern

›Antacid options

›Aluminum magnesium hydroxide antacid

›15 to 30 mL PO as needed

›Avoid in severe renal impairment

›Sucralfate

›1 g PO four times daily

›Separation from other medications by 2 hours

Acid suppression therapy

›Proton pump inhibitors for suspected gastritis or dyspepsia

›Omeprazole

›20 mg PO daily

›Increase to 20 mg PO twice daily for persistent symptoms

›Pantoprazole

›40 mg PO daily

›Increase to 40 mg PO twice daily for refractory symptoms

›H2 receptor antagonists

›Famotidine

›20 mg PO twice daily

›Renal dose adjustment for low eGFR

›Breakthrough symptom use

›Nighttime dosing strategy

›PPI intolerance alternative

Suspected upper GI bleed pharmacotherapy

›High dose PPI strategy for suspected ulcer bleeding

›Pantoprazole IV bolus

›80 mg IV once

›Transition to infusion strategy if endoscopic therapy planned

›Pantoprazole IV infusion

›8 mg per hour continuous infusion

›Typical duration 72 hours after hemostasis

›Prokinetic adjunct before endoscopy in selected cases

›Erythromycin IV

›250 mg IV once

›Administration 30 to 90 minutes before endoscopy

Helicobacter pylori eradication

›Indications for eradication therapy

›Positive noninvasive test

›Urea breath test positive

›Stool antigen positive

›Positive biopsy based test

›Rapid urease positive

›Histology positive

›First line empiric regimen when susceptibility unknown

›Optimized bismuth quadruple therapy for 14 days

›PPI

›Omeprazole 20 mg PO twice daily

›Alternative equivalent dose PPI twice daily

›Bismuth

›Bismuth subsalicylate 524 mg PO four times daily

›Alternative bismuth subcitrate per formulary

›Tetracycline

›500 mg PO four times daily

›Avoid substitution with doxycycline for eradication reliability

›Metronidazole

›500 mg PO three times daily

›Increase to 500 mg PO four times daily in selected protocols

›Clarithromycin triple therapy restrictions

›Use only with proven clarithromycin susceptibility

›PPI twice daily

›Amoxicillin 1 g PO twice daily

›Clarithromycin 500 mg PO twice daily

›Avoid empiric use in unknown resistance settings

›Prior macrolide exposure

›Regional high resistance patterns

›Test of cure requirements

›Urea breath test or stool antigen

›At least 4 weeks after antibiotics

›At least 2 weeks off PPI

Etiology specific measures

›NSAID associated gastritis strategy

›NSAID discontinuation

›Substitute acetaminophen when appropriate

›Avoid multiple NSAIDs

›Gastroprotection if NSAID must continue

›Daily PPI strategy

›Consider COX 2 selective agent risk benefit discussion

›Alcohol associated gastritis strategy

›Alcohol cessation

›Brief intervention

›Withdrawal risk screening

09Special Populations/sp42

Pregnancy

›Pregnancy specific considerations

›Differential broadening

›Hyperemesis gravidarum

›Preeclampsia related epigastric pain

›Medication safety

›PPI use when clinically indicated

›Famotidine as common option

›H pylori therapy constraints

›Avoid tetracycline

›Fetal bone and teeth risk

›Alternative regimens with specialist input

›Avoid bismuth subsalicylate

›Salicylate exposure concern

›OB consultation for alternatives

Geriatric

›Higher risk features

›Malignancy risk

›New dyspepsia threshold for endoscopy

›Weight loss significance

›Medication adverse effects

›NSAID related injury risk

›Antithrombotic bleeding risk

›Medication and monitoring considerations

›PPI risk balance

›Lowest effective dose

›Deprescribing plan after healing

›Renal dosing adjustments

›Famotidine dose adjustment

›Avoid aluminum containing antacids in advanced CKD

Pediatrics

›Pediatric red flags

›Bilious vomiting

›Obstruction concern

›Urgent imaging pathway

›GI bleeding

›Hematemesis evaluation

›Anemia assessment

›Pediatric management notes

›Weight based therapy approach

›PPI dosing per kg per local protocol

›Antiemetic dosing per kg per local protocol

›H pylori approach

›Testing based on guideline driven indications

›Specialist involvement for eradication regimens

10Background/b56

Epidemiology

›Epidemiologic overview

›Common causes

›Helicobacter pylori associated gastritis

›NSAID associated gastritis

›Presentation spectrum

›Dyspepsia predominant

›Occult bleeding possible

›Coding alignment

›ICD-10 gastritis codes

›K29.0 acute gastritis

›K29.7 gastritis unspecified

›Related coding links

›K25.x gastric ulcer

›K21.9 GERD

Pathophysiology

›Mucosal defense and injury balance

›Acid and pepsin exposure

›Direct epithelial injury

›Symptom generation via inflammation

›Prostaglandin mediated defense

›Mucus and bicarbonate production

›Mucosal blood flow support

›NSAID mechanism

›COX inhibition

›Reduced prostaglandins

›Increased susceptibility to injury

›Platelet function effects

›Bleeding risk amplification

›Ulcer complication risk

›Helicobacter pylori mechanism

›Chronic inflammation induction

›Antral predominant gastritis pattern

›Ulcer risk increase

›Malignancy association

›Atrophic gastritis progression risk

›Gastric cancer risk context

Therapeutic Considerations

›Acid suppression rationale

›PPI mechanism

›Proton pump inhibition

›Enhanced mucosal healing

›H2 blocker role

›Acid reduction

›Breakthrough symptom management

›H pylori eradication rationale

›Ulcer recurrence reduction

›Long term benefit after cure

›Reduced rebleeding risk in ulcer disease context

›Need for test of cure

›Persistent infection risk

›Resistance driven failure risk

›Guideline framing

›Test and treat approach for dyspepsia in younger patients without alarm features

›Noninvasive H pylori testing first

›PPI trial if negative or persistent symptoms

›Risk stratification for upper GI bleeding

›Very low risk discharge candidates using Glasgow Blatchford score

›Transfusion threshold strategy when hospitalized

11Patient Discharge Instructions/pdi31

copy discharge instructions

›Symptom care plan

›Diet and hydration

›Small frequent meals

›Avoid alcohol

›Trigger avoidance

›Avoid NSAIDs

›Avoid tobacco and vaping exposure

›Medication instructions

›PPI or H2 blocker use as prescribed

›Daily timing consistency

›Do not stop early if improving

›Antacid or sucralfate as needed

›Separation from other medications

›Constipation awareness

›Return to ED now criteria

›Bleeding signs

›Vomiting blood

›Black tarry stool

›Instability signs

›Fainting

›New chest pain

›Complication signs

›Severe worsening abdominal pain

›Fever

›Follow up plan

›Clinician follow up

›Within 1 to 2 weeks if persistent symptoms

›Earlier if worsening

›H pylori testing or results review

›Complete prescribed regimen if positive

›Test of cure scheduling after therapy

12References/r14

Clinical guidelines and key sources

›Guideline sources

›ACG Clinical Guideline Treatment of Helicobacter pylori infection 2024

›Optimized bismuth quadruple therapy for 14 days as preferred empiric regimen

›Avoid empiric clarithromycin triple therapy unless susceptibility known

›ACG and CAG Clinical Guideline Management of Dyspepsia 2017

›Age 60 years or older with dyspepsia as endoscopy threshold

›Test and treat H pylori strategy for age under 60 years without alarm features

›Upper GI bleeding guidance

›ACG Clinical Guideline Upper gastrointestinal and ulcer bleeding 2021

›Very low risk discharge candidates with Glasgow Blatchford score 0 to 1

›RBC transfusion threshold 7 g per dL for hospitalized upper GI bleeding

›ESGE Guideline nonvariceal upper GI hemorrhage update 2021

›Endoscopy timing within 24 hours after resuscitation in most cases

›Avoid emergent endoscopy within 6 hours in stable nonvariceal bleeding

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.