Gastritis is an acute or chronic inflammation of stomach. It is usually diagnosed on upper gastrointestinal endoscopy and can be confirmed and classified histologically by performing gastric biopsy.
It is also called as erosive or hemorrhagic gastritis.
Common causes of acute gastritis include:
- Excessive use of aspirin and other NSAIDs (non-steroidal pain killer drugs) and other drugs like iron, potassium chloride.
- Overconsumption of alcohol.
- Central nervous system trauma (Curling’s ulcer).
- Acute H. pylori infection
- Burns (Cushing’s ulcer)
- Bile reflux
- Severe trauma
Out of these most common cause is use of aspirin and other NSAIDs. These agents cause gastric mucosal damage by inhibiting prostaglandins, gastric bicarbonate and mucus and altering gastric mucosal micro circulation.
The mucosal damage can result in either slow upper gastrointestinal (GI) bleeding which can be detected as positive fecal occult blood test or can present as massive upper GI bleed.
In some patients, epigastric discomfort, anorexia and nausea may be present.
Treatment For Acute Gastritis
- Omission of causative agents like NSAIDs and aspirin.
- Use of acid-suppressive agents such as H2 receptor antagonists (ranitidine) and proton pump inhibitors (like omeprazole and pantaprazole).
- Prostaglandin analogues like misoprostol (more useful for prevention) and cytoprotective agents like sucralfate can be used.
Chronic Gastritis Symptoms
The two main types of chronic gastritis are:
- Autoimmune or type A
- H pylori associated or type B
Autoimmune gastritis – This involves the gastric body and spares the antrum.Parietal cell and intrinsic factor antibodies are serum markers of autoimmune chronic gastritis. Patients present with pernicious anemia (megaloblastic anemia with absolute achlorhydria) and features of vitamin B12 deficiency. Also autoimmune chronic gastritis is a pre-malignant condition and can progress to gastric cancer.
H. pylori associated chronic gastritis – This usually involves the antrum but over a period of time may involve the body as well. An uncommon cause of chronic gastritis is Menetrier’s disease or hypertrophic gastritis. The commonest presentation is in middle age with features of protein losing enteropathy.
On the upper GI endoscopy, enlarged rugal folds in fundus and body of stomach are evident.
Treatment For Chronic Gastritis
- H. pylori eradication should be done.
- Proton pump inhibitors are used which may also help decreasing protein loss.
- In patients who do not respond to above treatment, gastric resection may become necessary.