Gastritis: Causes, Symptoms and Treatment Guideline

Introduction

Gastritis is a disease condition where there is an inflammation of the gastric mucosa. The inflammation can be caused by many factors, including infection, stress resulting from severe illness, injury, certain drugs, and disorders of the immune system. Gastritis can be acute or chronic. The most important risk factors for acute gastritis include use of drugs (Non Steroidal Anti-inflammatory Drugs in particular) and alcohol.

H.pylori infection is the most important risk factor for chronic gastritis. All agents of gastritis work through the common path of disrupting the protective mucosal barrier of the stomach. Acute gastritis may evoke pain that mimics peptic ulcer disease. Chronic gastritis is a precursor of peptic ulcer disease (type B gastritis) and gastric cancer (type A gastritis).

Types and Causes of Gastritis

Gastritis is divided into two categories based on how severe it is:

  1. Erosive Gastritis: this is commonly caused by alcohol, stress resulting from severe illness, and irritants such as drugs, especially aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs ). Less common causes include Crohn disease , radiation, bacterial and viral infections (such as cytomegalovirus ), the ingestion of corrosive substances, and direct injuries to stomach lining (such as by the insertion of a nasogastric tube).
  2. Non erosive Gastritis: caused by H.pylori infection

Symptoms of Gastritis

Chronic gastritis is essentially asymptomatic. Acute gastritis evokes acute abdominal pain that mimics peptic ulcer disease. Nausea and intermittent vomiting can result from more severe forms of gastritis such as erosive gastritis and radiation gastritis.

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Occasionally, acute gastritis may be haemorrhagic with melaenal stools or rarely haematemesis

Complications of Gastritis

Acute gastritis

  • Haemorrhage

Chronic gastritis

  • Peptic ulcer disease
  • Gastric cancer

Differential diagnosis of Gastritis

  • Peptic ulcer disease (acute gastritis)

Investigations or Diagnosis

  • Endoscopy (macroscopic diagnosis)
  • Histology of gastric biopsy for definitive diagnosis

Treatment objectives

  • Eliminate pain (acute gastritis)
  • Prevent progression to peptic ulcer disease or gastric cancer
  • Re-establish normal histology

Drug treatment Acute Gastritis

  • Antacids

Magnesium trisilicate 1 – 2 tablets or suspension 10 mL orally three times daily or as required

Or:

Histamine receptor antagonist 2

Ranitidine 150 mg orally once daily or as required

Or:

Proton pump inhibitors

Omeprazole 20 mg orally once daily or as required

Type A gastritis

Endoscopic surveillance every 2-3 years for early detection of cancer

Type B gastritis:

Eradication of H.pylori using triple therapy with Clarithromycin 500 mg orally twice daily for 7 days

Plus:

Amoxicillin 1g orally every 12 hours for 7 days Plus:

Omeprazole 20 mg orally every 12 hours for 7 days

Prevention of Gastritis

Avoid risk factors (NSAIDs, alcohol, or other established triggers of Gastritis)

References

  1. Merck Manual: Gastritis
  2. NHS: Gastritis

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