HISTORY. Obtain a detailed history of past illnesses, as well as the onset, duration, and aggravating and relieving factors of any symptoms. Common symptoms include epigastric pain, changes in stool color, nausea and vomiting (emesis may be bright red, coffee ground, or bile colored), and appetite and weight changes. Assess the patient's usual daily diet, including alcohol, tea, and coffee ingestion. Obtain a complete medication profile that includes both prescribed and over-the-counter (OTC) drugs. Patients with gastritis may have only mild epigastric discomfort or intolerance for spicy or fatty foods. Patients with atrophic gastritis may be asymptomatic.

PHYSICAL EXAM. The patient may appear normal or may seem to be in discomfort, with facial grimaces and restlessness. Inspect for signs of dehydration or upper GI bleeding, which may be the only sign of acute gastritis. Bleeding can range from a sudden hemorrhage to an insidious blood loss that can be detected only by stool guaiac testing for occult blood or an unexplained anemia. Pallor, tachycardia, and hypotension occur with dramatic GI bleeding accompanied by hematemesis and melena.

Auscultate for decreased bowel sounds, which may or may not accompany gastritis. Palpate the abdomen to evaluate the patient for distention, tenderness, and guarding. Epigastric pain and abdominal tenderness are usually absent with patients who have GI bleeding. Gastritis caused by food poisoning and corrosive agents (ingestion of strong acids) results in epigastric pain, nausea, and vomiting.

PSYCHOSOCIAL. Assess the patient's and family's anxiety and ability to cope with the fears that are associated with hemorrhage. Assess the patient's understanding of disease management and his or her coping abilities to participate in lifestyle modifications.

Diagnostic Highlights

Test	Normal Result	Abnormality with Condition	Explanation
Esophagogastroduodenoscopy with biopsy	Visualization of normal stomach; biopsy results show normal cells	Visualization of inflamed gastric mucosa; biopsy results show the specific type of gastritis	Demonstrates location and depth of inflammation of stomach lining and rules out gastric cancer

Other Tests: Supporting tests include upper GI x-rays, serum tests, biopsy to determine histological evidence of H. pylori, enzyme-linked immunosorbent assay for H. pylori immunoglobulins.