Gastritis

Gastritis is inflammation of the gastric mucosa. The word comes from the Greek gastro- meaning of the stomach and -itis meaning inflammation. Depending on the cause, it may persist acutely or chronically and may coincide with more serious conditions such as atrophy of the stomach.

Causes

The following are known causes and factors related to gastritis:

• Bacterial infection (most often by Helicobacter pylori and other Helicobacter spp.)
• Fungal infection (most often in people with immunodeficiency)
• Parasitic infection (most often by Anisakis spp. from poorly cooked seafood)
• Viral infection
• Bile reflux
• NSAIDs
• Cigarette smoke
• Autoimmune disorders
• Excessive alcohol consumption
• Excessive caffeine consumption
• Certain allergens
• Certain types of radiation
• Stomach injury
• Stress

Symptoms:

The following symptoms can be a result of gastritis or can be related to the underlying cause:

• Upper abdominal pain or discomfort
• Gastric hemorrhage
• Hypochlorhydria
• Appetite loss
• Belching
• Nausea
• Vomiting
• Fever
• Lethargy (mild impairment of consciousness)

• Patients typically present with abdominal pain that has the following characteristics:

• • Epigastric to left upper quadrant
  • Frequently described as burning
  • May radiate to the back
  • Usually occurs 1-5 hours after meals
  • May be relieved by food, antacids (duodenal), or vomiting (gastric)
  • Typically follows a daily pattern specific to patient

• NSAID-induced gastritis or ulcers are usually silent.
• Sudden onset of symptoms may indicate perforation.
• Gastritis may present as bleeding, which is more likely in elderly patients.
• Symptoms consistent with anemia (eg, fatigue, dyspnea) may manifest.

Physical:

• Epigastric tenderness is present and usually mild.
• Bowel sounds are normal.
• Signs of peritonitis or GI bleeding may be manifest. Perform a rectal examination and Hemoccult testing.

Complications

Left untreated, gastritis may lead to stomach ulcers and stomach bleeding. Some forms of chronic gastritis may increase your risk of stomach cancer, especially if you have extensive thinning of the stomach lining and changes in the lining cells.

Tell your doctor if your signs and symptoms aren’t improving despite treatment for gastritis.

Prevention

Although you can’t always prevent H. pylori infection, these suggestions can help reduce your risk of gastritis:

• Eat smart. If you experience frequent indigestion, eat smaller, more frequent meals to help ease the effects of stomach acid. In addition, avoid any foods you find irritating, especially those that are spicy, acidic, fried or fatty. While taking these steps can reduce the signs and symptoms you experience, they can’t prevent gastritis.
• Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining of your stomach, causing inflammation and bleeding.
• Don’t smoke. Smoking interferes with the protective lining of the stomach, making your stomach more susceptible to gastritis as well as ulcers. Smoking also increases stomach acid, delays stomach healing and is a leading risk factor for stomach cancer. Still, stopping isn’t easy, especially if you’ve smoked for years. Talk to your doctor about methods that may help you stop smoking.
• Switch pain relievers. If possible, avoid taking NSAIDs — aspirin, ibuprofen and naproxen. These over-the-counter medications can cause stomach inflammation or make existing irritation worse. Instead, switch to pain relievers containing acetaminophen.
• Follow your doctor’s recommendations. Your doctor may recommend that you take an over-the-counter antacid or acid blocker to help prevent recurring gastritis.

Self-care

Digestive problems ranging from simple stomach upset to stomach cancer can occur for many reasons, including lifestyle choices you can control. In general, to keep your digestive system healthy, doctors recommend that you:

• Practice good eating habits. Just as important as what you eat is the manner in which you eat. Eat moderate proportions, eat at regular times and relax while you eat.
• Maintain a healthy weight. Digestive problems can occur no matter what your weight. But heartburn, bloating and constipation tend to be more common in people who are overweight. Maintaining a healthy weight can often help prevent or reduce these symptoms.
• Get plenty of exercise. Aerobic exercise that increases your breathing and heart rate also stimulates the activity of intestinal muscles, helping to move food waste through your intestines more quickly. It’s best to aim for at least 30 minutes of aerobic activity every day. Check with your doctor before you begin an exercise program.
• Manage stress. Stress increases your risk of heart attack and stroke, dampens your immune system and can trigger or aggravate skin problems. It also increases stomach acid production and slows digestion. Because stress is unavoidable for most people, the key is to learn to handle it effectively — a task that’s made easier by a nutritious diet, adequate rest, regular exercise and healthy ways to relax. If you have trouble relaxing, consider taking up meditation or studying yoga or tai chi. These disciplines can help focus your mind, calm your anxieties and reduce physical tension. In addition, therapeutic massage may loosen taut muscles and calm frazzled nerves.

How Is Gastritis Diagnosed?

After reviewing your personal and family medical history and performing a thorough physical evaluation, your doctor may recommend any of the following tests to diagnose gastritis.

• Upper endoscopy. An endoscope, a thin tube containing a tiny camera, is inserted through your mouth and down into your stomach to look at the stomach lining. The doctor will check for inflammation and may perform a biopsy, a procedure in which a tiny sample of tissue is removed and then sent to a laboratory for analysis.
• Blood tests. The doctor may perform various blood tests such as checking your red blood cell count to determine whether you have anemia, which means that you do not have enough red blood cells. He or she can also screen for H. pylori infection and pernicious anemia with blood tests.
• Fecal occult blood test (stool test). This test checks for the presence of blood in your stool, a possible sign of gastritis.

How Is Gastritis Treated?

Treatment for gastritis usually involves:

• Taking antacids and other drugs to reduce stomach acid, which causes further irritation to inflamed areas.
• Avoiding hot and spicy foods.
• For gastritis caused by infections, your doctor will prescribe a regimen of several antibiotics plus some sort of acid blocking drug (a heartburn drug).
• If the gastritis is caused by pernicious anemia, B12 vitamin shots will be given.

Once the underlying problem disappears, the gastritis usually does, too. You should talk to your doctor before stopping any medicine or starting any gastritis treatment on your own.

What Is the Prognosis for Gastritis?

Most cases of gastritis improve quickly once treatment has begun.

Drug Category: Antacids — Aluminum-containing and magnesium-containing antacids can be helpful in relieving symptoms of gastritis by neutralizing gastric acids. These agents are inexpensive and safe.

Drug Name	Aluminum and magnesium hydroxide (Maalox, Mylanta) — Neutralizes gastric acidity, resulting in increase in stomach and duodenal bulb pH. Aluminum ions inhibit smooth muscle contraction, thus inhibiting gastric emptying. Magnesium and aluminum antacid mixtures are used to avoid bowel function changes.
Adult Dose	2-4 tsp PO qid prn
Pediatric Dose	0.5 mL/kg PO qid prn
Contraindications	Documented hypersensitivity
Interactions	Both drugs reduce efficacy of fluoroquinolones, corticosteroids, benzodiazepines, and phenothiazines; aluminum and magnesium potentiate effects of valproic acid, sulfonylureas, quinidine, and levodopa
Pregnancy	C – Safety for use during pregnancy has not been established.
Precautions	Use aluminum containing antacids with caution in patients who have recently suffered a massive upper GI hemorrhage