Gastritis is an inflammation of the gastric mucosa or stomach lining. This happens when the protective barrier of the stomach is broken, resulting in injury of the mucosa. In one classification system, according to the severity of the mucosal injury, gastritis is divided into two categories: erosive or nonerosive. Erosive gastritis normally does not cause much inflammation, but can wear away (erode) the gastric mucosa. Therefore, erosive gastritis is likely to cause bleeding or ulcers.
Gastritis can also be categorized according to the site of the injury (ie, cardia, body, antrum) or according to the inflammatory cell type involved in acute or chronic. Acute gastritis is an abrupt and severe inflammation of the stomach wall, while chronic gastritis occurs over an extended period of time. The pathophysiology of gastritis does not necessarily follow certain patterns within these classes, and different types of gastritis might have similar pathological features and symptoms.
Gastritis may involve acid-peptic and H. pylori diseases. The term may also be used non-specifically, referring to abdominal discomfort and gastroenteritis.
The onset of gastritis may be caused by Helicobacter pylori (H. pylori), a bacterium that lives in the stomach and can cause acute and chronic infection. H. Pylori is one of the most common infectious agents responsible for gastritis. In industrialized countries, it is estimated that 20 to 50 percent of the population is infected with H. pylori. The incidence is likely higher in areas where sanitary conditions are poor and in places with a high population density. Other infectious agents that cause gastritis can be found in people with immunosuppressive disorders or autoimmune disorders such as acquired immunodeficiency syndrome (AIDS) and pernicious anemia (Vitamin B12 deficiency).
Too much alcohol intake and tobacco consumption can also cause injury to the stomach lining. People experiencing stress may have increased gastric acid secretion in the stomach leading to gastritis.
Prolonged use of nonsteroidal anti-inflammatory drugs (NSAID's), such as ibuprofen and aspirin are becoming a more common cause of gastritis. Accidental or intentional ingestion of corrosive substance, such as drain cleaners or poisons, can cause irritation and damage to the stomach. Gastritis can also occur as the result of bile backflow to the stomach.
Long-term inflammation of the gastric mucosa due to chronic gastritis can lead to changes in cell morphology and shape (metaplasia). Metaplastic conditions such as Barrett's esophagus are often associated with a higher risk of cancer.
The symptoms of gastritis are diverse and can range from mild to severe.
- Dyspepsia (heartburn)
- Nausea and vomiting (including vomiting blood)
- Upper abdominal pain or discomfort
- Loss of appetite
- Black tarry stools
- Pain that is relieved by eating
There are different diagnostic assessments that can be made:
- Blood tests to check for anemia and infection with Helicobacter pylori.
- Fecal occult blood test or stool test to detect blood from internal bleeding along the gastrointestinal tract.
- Esophagogastroduodenoscopy (EGD) is an endoscopic procedure coupled with biopsy that allows checking for Helicobacter pylori and gastric cancer.
- X-ray with barium swallowing to capture images of the stomach and small intestine. It will permit the detection of lesions in the stomach wall.
Treating gastritis involves addressing the symptoms and underlying cause(s). The following medical treatments may be administered:
- Histamine-2 receptor antagonists (cimetidine, ranitidine hydrochloride, famotidine) to reduce stomach acid production.
- Antacids, used as a pH buffers to quickly relieve pain and indigestion by neutralizing gastric acids.
- Proton pump inhibitors (rabeprazole, lansoprazole, pantoprazole, omeprazole, esomeprazole magnesium) to reduce gastric acid production.
- Antibiotics to treat Helicobacter pylori infection.
Diet therapy can be very useful to reduce or prevent symptoms of gastritis. In this approach, the intake of spicy foods, alcohol and tobacco consumption is limited or completely avoided.
The prognosis of uncomplicated gastritis is good because there are available treatments that can help to effectively manage the condition. In chronic and severe cases of gastritis, the patient may suffer from other related conditions that can affect prognosis. Patients with prolonged gastritis should be closely monitored.
Gastritis may, in some cases, be prevented by reducing the exposure to agents that irritate and cause damage to your stomach, such as alcohol and smoking.
People suffering from gastritis should eat a healthy and balanced diet and drink plenty of water. Stress should be avoided or appropriately managed with relaxation techniques. It is important to keep a positive attitude and to discuss your condition with your doctor and family.
Given the ethiological diversity of gastritis, research is ongoing in many different areas, ranging from pathological mechanisms of autoimmune gastritis to clinical evaluation of new treatments. With the introduction of antibiotic therapy to treat H. pylori-related gastritis, the incidence of this form of gastritis is declining and research is gearing towards the understanding of H. pylori-negative conditions.