Gastritis

Gastritis is the inflammation of the mucosa (lining) of the stomach. The mucosal layer contains some mucous glands which produce a lubricating and protecting fluid called mucous that protects the stomach lining from the harsh acidic environment. Due to some causes, this lining is disrupted and inflamed, resulting in gastritis that causes the symptoms of gastric pain and burning, nausea, bloating, etc. The treatment requires eliminating the cause and some medicines that control acid production, protect against acid and provide relief. 

Anything that can damage the protective lining of the stomach may cause gastritis. Some of the causes are;

Infections: One of the most common causes is a bacterial infection with a bacteria known as Helicobacter pylori (H. pylori). These bacteria enter the body and live in the digestive tract, damaging the mucosa and causing inflammation or ulceration. Some other agents like viruses (cytomegalovirus), fungi (Candidiasis, histoplasmosis), and parasites can also cause gastritis.

Medicines: (NSAIDs) Nonsteroidal anti-inflammatory drugs such as Aspirin, ibuprofen, and naproxen sodium damage the gastric mucosal barrier causing gastritis.

Smoking and Alcohol abuse: Prolonged use of smoking and alcohol can cause irritation and erosion of the lining. They also decrease the chances of healing and increase the risk of recurrence.

Physical and mental stress: Any severe physical illness or mental stress can cause gastritis. Patients admitted to ICU and burn units often develop gastritis. Radiations can also cause gastritis.

Autoimmune disease: Sometimes, your body’s defense system attacks its stomach cells, known as autoimmune gastritis.  

Bile reflux: In your body, a fluid called bile is produced by the liver to aid in the digestion of fatty food. Sometimes the bile flows back into the stomach instead of flowing forwards in the intestines, causing irritation and damage to stomach mucosa. 

When the condition starts suddenly and is of short duration, it is called acute gastritis. If it starts gradually and lasts a little longer, it is known as chronic gastritis. Rarely, acute gastritis does not resolve and takes the course of chronic gastritis. Some causes of chronic gastritis include Autoimmune gastritis, lymphocytic gastritis, eosinophilic gastritis, radiations, chronic granulomatous gastritis, and Ischemic gastritis. Gastritis is also classified into two other categories;

Erosive gastritis: In this type, there is abrasion of the lining. Most common causes include alcohol, smoking, NSAIDs, and steroid use.

Non-erosive gastritis: In this type, there is only inflammation, and the mucose is not abraded. A helicobacter pylori infection is one of the most common causes of it. 

Almost half of the world's population has been affected by gastritis. In 2013, 90 million new cases of gastritis were reported. In USA, It is accountable for around 1.8-2.1 million clinical visits yearly. The frequency of gastritis increases with age, and it tends to affect older people more.  

Having one of the following risk factors can increase your chances of getting gastritis;

·         Infection with Helicobacter pylori

·         Smoking

·         Excessive use of alcohol

·         Stress

·         Use of some medications

·         Suffering from severe illness

Sometimes, gastritis may not cause any symptoms. When it causes symptoms, they include;

·         Epigastric pain: A burning or gnawing pain is one of the most common symptoms.

·         Indigestion: Some people may feel bloating, belching, and fatty food intolerance.

·         Chest discomfort: People may also feel a burning sensation in the chest, usually known as heartburn.

·         Nausea/vomiting: Patients may also complain of feeling nauseated and may occasionally have vomiting.

·         Ulcers and Bleeding: Severe or untreated gastritis can cause ulcers that sometimes bleed, causing black tarry stools called melena. 

Your doctor will take a detailed history to ask about the possible risk factors causing gastritis. Your doctor may also advise some tests that are essential to confirm the diagnosis;

·         Tests for Helicobacter pylori bacteria: Your doctor may order laboratory tests on blood, stool, or breath (the Urease breath test) to find out the bacteria.

·         Endoscopy is a procedure of choice for the diagnosis of gastritis. In this test, a flexible tube with the camera is inserted through your mouth to visualize the inside of the esophagus, stomach, and duodenum. A biopsy can also be taken to detect H. pylori and gastric cancer, which is one of the complications of prolonged and untreated gastritis.

·         Barium meal x rays: In this test, you are given to swallow barium meal, after which a series of x-rays are taken that shows the ulcer. It is not used commonly now.

Some other conditions may mimic the symptoms of gastritis, like;

·         Peptic ulcer disease

·         Acute Cholecystitis and biliary colic

·         Acute Cholangitis

·         Acute coronary syndrome

·         Gastroesophageal Reflux Disease

·         Esophagitis

·         Diverticulitis

If you are having symptoms of gastritis, you may need to contact your healthcare provider.

The treatment involves removing the causative factors, eradicating the bacteria, and controlling the acid secretion of the stomach.

·         Medicines to eradicate h.pylori bacteria: This includes a 14-day course of a combination of antibiotics, including Amoxicillin, metronidazole, clarithromycin, or tetracycline.

·         Medicines to control acid secretion: H2 Receptor Antagonists are the first choice of therapy. They not only suppress acid secretion but also promote and hasten healing. Although Cimetidine can cause confusion in the elderly and gynecomastia and impotence in young males and the elderly, these drugs are generally safe. (PPI) proton pump inhibitors such as omeprazole are used in combination therapy for eradication of H. pylori and in treating reflux esophagitis.

·         Mucosal protective medicines: Drugs such as Sucralfate and Bismuth compounds enhance mucosal defenses. Misoprostol, a prostaglandin analog, promotes ulcer healing by promoting bicarbonate secretion and halting stomach acid secretion. The side effects are abdominal pain and diarrhea. Misoprostol is not as effective as other anti-ulcer drugs.

Gastritis is easy to treat, and most cases recover completely until the etiology is removed. Some chronic cases need prolonged treatment. It is very important to correct the underlying cause, upon failure of which, gastritis can re-occur. 

The recurrence of gastritis can be controlled by regularizing lifestyle changes. These include;

• Avoid smoking
• Avoid NSAIDs such as aspirin
• Taking rest and avoiding stress would be beneficial as stress causes the disease.
• Using moderate amounts of alcohol.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on November 14, 2023.

Reference

https://www.nhs.uk/conditions/gastritis/#:~:text=Gastritis%20is%20when%20the%20lining,include%20antacids%2C%20alginates%20and%20antibiotics.

https://www.tandfonline.com/doi/full/10.3109/00365521.2015.1019918