What is Gastritis?
Gastritis is the medical term for the inflammation of the stomach lining. Initially gastritis causes irritation of the stomach lining and with time it progresses into persistent inflammation that can lead to erosion, ulceration and degeneration of the entire stomach. The entire lining of the stomach may be affected or just portions of it. Gastritis can be acute (short term) or chronic (long term).
Causes of Gastritis
The mucous membrane of the stomach produces a mucus layer which coats the inside of the stomach. This prevents gastric acid from injuring the stomach wall. In gastritis, this mucus layer is compromised and the acid causes inflammation of the lining. However, there are other causes that may result in the inflammation of the stomach that is not related to the action of the stomach acid.
Gastritis may be caused by many factors, ranging from infections (bacterial, viral, fungal or parasites) to the use of certain substances like drugs and alcohol. It may also be caused by certain types of autoimmune diseases, stomach cancer, problems with blood supply to the stomach and injury or death of some of the stomach cells. Gastritis is sometimes just a symptom of an underlying disease or at times its a condition on its own that is not associated with any other medical condition.
Signs and Symptoms
The most common symptom of gastritis is a gnawing stomach pain which is commonly referred to as a stomachache. The other symptoms may include nausea with or without vomiting, discomfort in the stomach (not pain), feeling of being bloated or full after eating even small meals and excessive belching. All these symptoms may be described as indigestion (dyspepsia).
While gastritis is a separate condition, it is often found in cases of stomach ulcers or gastroesophageal reflux disease (GERD). This does not mean that gastritis will lead to or always complicate into these conditions – sometimes gastritis can persist on its own for long periods of time with no other gastric conditions developing. If other conditions, like ulcers and GERD is present, the symptoms of these conditions may also be evident.
Types of Gastritis
Broadly, gastritis can be classified as acute or chronic.
In acute gastritis, the symptoms can be very severe although short-lived and easily treated or there may be no symptoms (asymptomatic).
In chronic gastritis, the causes are usually more persistent and varied. Chronic gastritis develops gradually and the symptoms may continue for long periods of time. Like acute gastritis, it can at times cause no symptoms (asymptomatic) although severe symptoms may be present during acute exacerbation. Chronic gastritis may also result in complications like stomach ulcers or stomach bleeding.
There are different types of gastritis classified according to the cause or changes that occur in the stomach lining. This includes :
- Erosive gastritis
- Non-erosive gastritis
These types of gastritis (above) are usually acute in nature. However, there are a number of types of chronic gastritis (below) :
- Autoimmune chronic gastritis
- Atrophic gastritis
- Eosinophilic gastritis
- Gastritis in immunosuppression
- Granulomatous gastritis (inflammatory or non-inflammatory)
- H.pylori-associated gastritis
- Hemorrhagic gastritis or ulcero-hemorrhagic gastritis
- Hypertrophic gastritis (Menetrier’s disease)
- Ischemic gastritis
- Lymphocytic gastritis
- Postgastrectomy gastritis
- Reactive gastropathy
- Radiation gastritis
Hemorrhagic or ulcero-hemorrhagic gastritis may be a feature one or more types of gastritis (erosive gastritis, radiation gastritis) or other gastric conditions (like stomach cancer). At times, there is an overlap of the different types of gastritis.
Gastritis Treatment and Prevention
The effective treatment and management of gastritis depends on a conclusive diagnosis and assessment of the severity of the condition. This may involve one or more of the following investigations :
- Double-contrast barium study
- Stomach acid test
- Upper GI endoscopy with/without endoscopy
- Blood tests like a complete blood count (CBC)
- Tests to verify H.pylori gastritis (stool, breath and blood)
Medication for Different Types of Gastritis
The drugs that are commonly used in the treatment of gastritis include :
Other drugs like prostaglandin analogues and sucralfate are discussed further under Stomach Acid Medication. In addition, medication like corticosteroids or antibiotics may be used simultaneously for the treatment of different types of gastritis.
The main aim of treatment in acute gastritis is to provide immediate symptomatic relief. Further diagnostic investigation may not be necessary unless there are signs of complication like upper GI bleeding and progressive worsening of symptoms despite treatment. In terms of upper GI bleeding, other causes of stomach bleeding need to be excluded as persisting with gastritis treatment may exacerbate the actual cause.
If nausea and vomiting are present then antiemetics should also be considered. Oral rehydration therapy would be necessary to replenish fluid and electrolytes and prevent dehydration.
A number of NSAIDs and aspirin are frequently linked to gastritis. Discontinuing these offending agents is the first step in the treatment of gastritis. As mentioned under prevention of gastritis, enteric-coated aspirin may be better tolerated. If discontinuing the medication is not an option, then alternatives should be considered as advised by a doctor.
Proton pump inhibitors may be commenced and continued as a preventative measure if the offending drug cannot be discontinued. Prostaglandin analogues may be used simultaneously. H2-blockers should be considered if a PPI is not an option for the patient. If the symptoms do not ease, then the case should be further investigated especially for H.pylori infection.
Seriously ill patients are at a greater risk of developing stress-related gastritis with ulcer formation. Sucralfate is the drug of choice in prevention of stress-induced gastritis. Unlike PPIs and H2-blockers, the use of sucralfate does not increase the risk of hospital-acquired pneumonia. It is also useful in reducing active bleeding and prevent re-bleeding from stress ulcers. In some patients, a PPI and H2-blocker will be considered.
Ideally the exact cause should be isolated and removed, treated or managed. However, in chronic gastritis where the cause is unknown, treatment with PPIs or H2-blockers for 8 to 12 weeks may help to reduce the symptoms, possibly allow for the condition to resolve and assist with the healing of any ulcers.
- H.pylori-Associated Chronic Gastritis
- The treatment is discussed in detail under the H.pylori Gastritis article.
- The treatment of other causes of infectious gastritis, including fungi and other bacteria, are also discussed in this article.
- Lymphocytic Gastritis
- Chronic acid suppression with a proton pump inhibitor is usually recommended.
- Some cases of lymphocytic gastritis is known to heal spontaneously without any treatment.
- Eosinophilic Gastritis
- Food skin testing and a detailed evaluation is necessary to identify the cause and advise the patient on measure to avoid these allergens.
- A balanced amino acid based diet may be useful in food allergies that cannot be clearly identified.
- Mild symptoms can be managed without medication and in the event of severe symptoms associated with gastritis complications, corticosteroid drugs may be necessary.
- Corticosteroids itself can cause gastric irritation and may require simultaneous acid suppression therapy with a PPI.
- Patients with history of food allergies or intolerance may benefit from oral glucocorticoids (corticosteroid to regulate inflammation and immune activity) or mast cell stabilizers which inhibit the release of histamine from mast cells.
- Atrophic Gastritis
- In patients with atrophic gastritis associated with H.pylori infection, the eradication treatment for H.pylori should be commenced.
- In autoimmune atrophic gastritis, treatment should aim at correction of pernicious anemia with vitamin B12 administration at regular intervals.
Prevention of Gastritis
The exact contributing factors of gastritis, especially if unknown, may be unavoidable. However, known trigger factors should be avoided as far as possible or at least minimized significantly. Preventative measures are necessary for proper management of gastritis even with the use of medication to treat gastritis.
Some of the more common triggers include :
- Drugs like NSAIDS, particularly aspirin, and certain antibiotics
- Cigarette smoking
- Caffeinated beverages
- Hot and spicy foods
Individual irritants may be unique to each person suffering with gastritis. It is therefore advisable to record and closely monitor these trigger factors. In terms of NSAIDs, especially aspirin, it may not be possible to stop the medication. Instead paracetamol or enteric-coated aspirin, if permissible, may be better tolerated. Alternative types of antibiotics may be equally effective with minimal gastric upset. Always speak to your doctor before discontinuing or changing any medication.