Gastritis Disease

BASICS

DESCRIPTION

Inflammatory reaction in the stomach; typically involves the mucosa, seldom the full thickness of the stomach wall

Patchy erythema of gastric mucosa: a common endoscopic finding; usually insignificant
Erosive gastritis: a reaction to mucosal injury by a noxious chemical agent, e.g., drugs (especially NSAID's) or alcohol
Reflux gastritis: a reaction to protracted reflux exposure to bile and pancreatic juice, usually associated with a defective pylorus; typically limited to the prepyloric antrum
Hemorrhagic gastritis (stress ulceration): a reaction to hemodynamic disorder, eg, hypovolemia or hypoxia (as in shock). Also, very common in intensive care units (ICU)
Infectious gastritis: commonly associated with Helicobacter pylori (possibly causative, maybe opportunistic); viral infection, usually as a component of systemic infection, is common; significant infection by other specific microbes is rare
Gastric mucosal atrophy, sometimes called atrophic gastritis: frequent, in varying degrees, in the elderly; invariable in primary (pernicious) anemia
System(s) affected: Gastrointestinal
Genetics: Unknown (except, probably, for gastric mucosa atrophy)
Incidence/Prevalence in USA: N/A
Predominant age: All ages; an estimated 60% of persons older than 60 years harbor H. pylori in their gastric mucosa, but in only a small fraction is this significant
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Nondescript epigastric distress, often aggravated by eating
Anorexia
Nausea, with or without vomiting
Significant bleeding is unusual except in hemorrhagic gastritis
Hiccups

CAUSES

Alcohol
Aspirin and other nonsteroidal anti-inflammatory drugs
Bile reflux
Pancreatic enzyme reflux
Stress (hypovolemia or hypoxia)
Radiation
Staphylococcus aureus exotoxins
Bacterial infection (eg: Helicobacter pylori)
Viral infection
Pernicious anemia
Gastric mucosal atrophy
Portal hypertension gastropathy

RISK FACTORS

Age over 60
Exposure to potentially noxious drugs or chemical agents
Hypovolemia, hypoxia (shock)
Candidal autoimmune

DIAGNOSIS

LABORATORY

Usually unremarkable, except when blood loss results in anemia

Drugs that may alter lab results: Antibiotics or omeprazole may affect urea breath test for H. pylori
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Acute or chronic inflammatory infiltrate in gastric mucosa, often with distortion or erosion of adjacent epithelium. Presence of H. pylori may be confirmed.

SPECIAL TESTS

13C-urea breath test for H. pylori (not widely available)
Serologic test available for H. pylori (office and clinical laboratory), inexpensive
Gastric acid analysis may be abnormal, but is not a reliable indicator of gastritis

IMAGING

Nuclear scintigraphy not done clinically

DIAGNOSTIC PROCEDURES

Gastroscopy, usually with biopsy, is essential for a precise diagnosis

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient, except for severe hemorrhagic gastritis

GENERAL MEASURES

No specific therapy for gastritis (with the exception of H. pylori infection)
Parenteral fluid and electrolyte supplements required if vomiting prevents food intake
Consider discontinuing NSAIDs or adding misoprostol

SURGICAL MEASURES

N/A

ACTIVITY

Usually no restriction

DIET

Restriction, if any, depends on severity of symptoms (e.g., light, soft diet); avoid caffeine

PATIENT EDUCATION

Explanation, reassurance
Smoking cessation

FOLLOW UP

PREVENTION/AVOIDANCE

Patients should be warned of known or potentially injurious drugs or chemical agents
Patients liable to hypovolemia or hypoxia (especially patients confined to an intensive care ward) should receive prophylactic therapy

POSSIBLE COMPLICATIONS

Bleeding from extensive mucosal erosion or ulceration

EXPECTED COURSE AND PROGNOSIS

Most cases clear spontaneously when the cause has been identified and allayed
Recurrence of H. pylori infection may require a repeated course of treatment

MISCELLANEOUS

ASSOCIATED CONDITIONS

Gastric or duodenal peptic ulcer
Primary (pernicious) anemia
Portal hypertension

AGE-RELATED FACTORS

Pediatric: Gastritis rarely occurs in infants or children
Geriatric: Persons over 60 often harbor apparently harmless H. pylori infection
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

NSAID's = nonsteroidal anti-inflammatory drugs

Clinical Investigations

ROLE OF HOMOEOPATHY

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