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In simple terms the definition of gastritis is an inflammatory process in the gastric mucosa and
submucosa. Gastritis is a health disorder that is most often found in clinics, because the diagnosis is
often only based on clinical symptoms rather than histopathological examination. In most cases,
gastric mucosal inflammation does not correlate with patients' clinical complaints and symptoms. In
contrast, patients' clinical complaints and symptoms are positively correlated with complications of
gastritis. At this time a division of gastritis has been developed based on a system called the Sydney
System Update.
GASTRITISM DISTRIBUTION
The Sydney System update divides gastritis based on topography, mortology and etiology. Broadly
speaking, gastritis is divided into 3 types namely: 1. Monahopic, 2. atropic and 3. special shape. In
addition to the above divisions, there is a form of gastric abnormality which is classified as
gastropathy. So called because histopathologically does not describe inflammation. Classification of
gastritis according to the Sydney System Update requires gastroscopic action, histopathological
examination and investigations to determine its etiology. Biopsy must be done with the right
method, evaluated so that the morphology and topography of mucosal abnormalities can be
synthesized. Many gastroscopic actions ignore topography when taking specimens for
histopathological examination. As a result the results cannot be synthesized, so the classification of
gastritis cannot be arranged properly.
ETIOLOGY
DIAGNOSIS
Most symptomatic gastritis. Those who have complaints are usually not typical complaints.
Complaints often associated with gastritis are hot and painful pain in the pit of the stomach
accompanied by occasional nausea to vomiting. These complaints actually do not correlate well with
gastritis. These complaints also cannot be used as a tool to evaluate treatment success. Physical
examination also cannot provide information needed to make a diagnosis. The diagnosis is based on
endoscopic and histopathological examination. It is best to carry out biopsies systematically in
accordance with the sydney system update describing often also possible morphological changes
which require topography. Endoscopic features that can be found are erythema, exudative, flaring-
erosion, raised erosion, bleeding, edematous rugae. Histopathological changes in addition to
describing the underlying poses, for example the autoimmune adaptive response of the gastric
mucosa. changes that occur in the form of epithelial degradation, foveolar hyperplasia, neutrophil
infiltration, mononuclear cell inflammation, limpoid follicles, atrophy, intestinal metaplasia,
endocrine cell hyperplasia, parietal cell damage. Histopathological examination should also include
examination of HP bacteria.
TREATMENT
Treatment of gastritis due to bacterial infection HP aims to make the germs radicalized. At this time
a universally approved indication for eradication is an HP bacterial infection that has to do with
peptic ulceration and erection related to low grade B cell lymphoma. As if patients suffering from
non HP dyspepsia eradication of these germs are still expected to be able to suppress the incidence
of atrophy and metaplasia in patients who have been infected. Furthermore, it can prevent peptic
ulcers, gastric cancer and ulcers, even though they are associated with disputed germ infections.
Those who agree argue that germ eradication is reviewed from the epidemiology of lymphoma.
Those who do not agree to consider that not enough evidence of eradication can have such broad
implications. Eradication is done by a combination of various antibiotics and proton pump inhibitors
(PP). The recommended antibiotics are clarithomycin, amoxicillin, metronidazole and tetracycline. If
PPI and a combination of 2 failed antibiotics are recommended, add bismuth subsalicylate / subsitral
(Table 1) Management of autoimmune gastritis is aimed at 2 things, namely cobalamin deficiency
and lesions in the gastric mucosa. Gastric mucosal atrophy is an irreversible condition. Germs often
together with other autoimmune diseases, should the accompanying disease be treated. Repairing
cobalamin difficiency can often correct complications arising from these dificiency. Complications in
the form of pathological abnormalities are indeed more difficult to overcome. It is thought to
conduct surveillance of the possibility of cancer by periodic gastroscopic examination. Lymphocytic
gastritis, often related to HP infection, if it is proven, eradication can be done and often brings
improvements. There is no specific therapy for idiopathic lymphocytic gastritis. Standard dose PPIs
can be tried and often provide improvement. While lymphocytic gastritis accompanying other
diseases, such as gluten enteropathy, management is aimed at primary disease.
Referensi :
Sudoyo, Aru W. dkk. Buku Ajar Ilmu Penyakit Dalam. Jilid II Edisi VI.Jakarta: Interna Publishin
g Pusat Penerbitan Ilmu Penyakit Dalam. Hal 1770-1772