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K29.4 – Chronic Atrophic Gastritis
K29.4 is the ICD-10 code for chronic atrophic gastritis – a long-term inflammation of the stomach lining with progressive glandular tissue loss and reduced gastric function.
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K29.4 is the ICD-10 code for chronic atrophic gastritis – a long-term inflammation of the stomach lining with progressive glandular tissue loss and reduced gastric function.
What is K29.4?
The ICD-10 code K29.4 refers to chronic atrophic gastritis. This is a long-term inflammatory condition of the stomach lining in which the gastric glands progressively deteriorate – a process known as atrophy. The reduction in glandular cells leads to decreased production of gastric acid, digestive enzymes, and the intrinsic factor, which is essential for the absorption of vitamin B12.
Causes
Chronic atrophic gastritis can develop due to several underlying causes:
- Helicobacter pylori infection: The bacterium Helicobacter pylori is the most common cause. It colonizes the stomach lining and triggers persistent inflammation that can lead to atrophy over many years.
- Autoimmune gastritis (Type A): In this form, the immune system attacks the parietal cells of the stomach lining. This type is associated with vitamin B12 deficiency and pernicious anemia.
- Chronic irritation: Long-term alcohol consumption, regular use of non-steroidal anti-inflammatory drugs (NSAIDs), or persistent bile reflux may also contribute to the development of atrophic gastritis.
Symptoms
Chronic atrophic gastritis often progresses for years with few or no symptoms. When symptoms do occur, they may include:
- Dull pressure or pain in the upper abdomen
- Nausea and bloating
- Early feeling of fullness after eating
- Loss of appetite
- In cases of vitamin B12 deficiency: fatigue, dizziness, tingling in the hands and feet (polyneuropathy)
Diagnosis
Diagnosis is typically established through gastroscopy (upper endoscopy), during which tissue samples (biopsies) are taken and examined under a microscope. Additional diagnostic measures include:
- Helicobacter pylori testing: such as breath tests, stool antigen tests, or biopsy-based tests
- Blood tests: measuring vitamin B12, ferritin, complete blood count, and antibodies against parietal cells or intrinsic factor (in autoimmune gastritis)
- Serum pepsinogen I/II ratio: used as a biomarker for the degree of gastric mucosal atrophy
Treatment
Treatment depends on the underlying cause:
- Helicobacter pylori eradication: If infection is confirmed, a combination therapy of two antibiotics and a proton pump inhibitor (PPI) is administered (triple therapy).
- Vitamin B12 supplementation: In autoimmune gastritis with intrinsic factor deficiency, regular vitamin B12 supplementation – usually via injection or high-dose oral preparations – is necessary.
- Dietary adjustments: Avoiding irritants such as alcohol, caffeine, and NSAIDs is recommended.
- Regular endoscopic follow-up: Since chronic atrophic gastritis is considered a risk factor for the development of stomach cancer, periodic gastroscopy is advised for surveillance.
References
- Malfertheiner P. et al. – Management of Helicobacter pylori infection: the Maastricht V/Florence Consensus Report. Gut, 2017; 66(1):6–30.
- Lahner E., Annibale B. – Pernicious anemia: new insights from a gastroenterological point of view. World Journal of Gastroenterology, 2009; 15(41):5121–5128.
- World Health Organization (WHO) – International Classification of Diseases, 10th Revision (ICD-10), Chapter XI: Diseases of the Digestive System (K00–K93).
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