Gastric Tuberculosis

Gastric TB is the rarest organ TB. Benjamin (1933) collected only 225 cases worldwide; Good found only 3 among 7416 gastric surgeries. Why late-stage TB patients have intestinal TB so often but gastric TB so rarely is unclear, possibly related to gastric bactericidal power and lack of lymphoid follicles in the gastric wall.

Common Symptoms

Abdominal discomfort; fever; weight loss; abdominal distension; night sweats; abdominal pain; fatigue; nausea; belching

Causes and Pathogenesis

Almost all are secondary; the primary focus is pulmonary TB in over half, otherwise intestinal, bone, or adnexal TB. Routes to the gastric wall: direct mucosal invasion; hematogenous/lymphatic spread; direct spread from adjacent foci; or superinfection of benign ulcers/malignancies. (1) Site: usually the pylorus and prepyloric lesser curvature, rarely the body or greater curvature. (2) Pathological types: ulcerative (most common, ~80%; shallow irregular ulcers with gray-white bases; large penetrating ulcers/fistulas rare; massive hemorrhage rare; scarring causes pyloric obstruction); mass-forming (inflammatory hypertrophy/adhesions causing obstruction); miliary nodular (part of systemic miliary TB); inflammatory proliferative (diffuse infiltration with thickened wall and polypoid mucosa). (3) Histology: adjacent nodes are enlarged with caseation; typical caseating granulomas in mucosa/submucosa rarely involve the muscularis; acid-fast bacilli on staining.

Treatment

Drug therapy, rehabilitation

Preventive Measures

The main measure is active prevention and treatment of primary TB. Since the 1990s, previously controlled pulmonary TB has resurged worldwide; drug-resistant strains are harder to treat, making prevention crucial. Seek prompt care for unexplained low fever, weight loss, fatigue, cough, or night sweats. Take regular full-course therapy under specialist guidance for at least half a year; rest, nutrition, and outdoor activity are essential. Sputum-positive patients should be isolated to protect family, especially children.

Department to Visit

It is recommended to visit the Gastroenterology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.