| Gastritis Classification and external resources |
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| ICD-10 | K29.0-K29.7 |
|---|---|
| ICD-9 | 535.0-535.5 |
| eMedicine | emerg/820 med/852 |
| MeSH | D005756 |
Gastritis is an inflammation of the lining of the stomach. There are many possible causes.[1] Gastritis is caused by excessive alcohol consumption, prolonged use of nonsteroidal anti-inflammatory drugs, also known as NSAIDs, such as aspirin or ibuprofen, or infection with bacteria, such as Helicobacter pylori. Sometimes gastritis develops after major surgery, traumatic injury, burns, or severe infections. Certain diseases, such as pernicious anemia and chronic bile reflux, or autoimmune disorders, can cause gastritis as well. Gastritis may also occur in those who have had weight loss surgery resulting in the banding or reconstruction of the digestive track. The most common symptom is abdominal upset or pain. Other symptoms are indigestion, abdominal bloating, nausea, and vomiting, or a feeling of fullness or burning in the upper abdomen. Blood in vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem[2].
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H. Pylori is the most common cause of gastritis.[3] H. pylori is found in 90% of gastritis patients[4]. Of the US population, 40% harbors the bacterium.[5] In just the past few years have scientists recognized its role in gastritis[6]. H. pylori lives in the protective mucous layer of the stomach; it also erodes this layer. These bacteria's flagella attach to the underlying stomach cells. The mucous layer protects the H. pylori from stomach acid. These bacteria do not invade the stomach cells, however. Infection-fighting white blood cells move into the infected area, and the body develops H. pylori-specific antibodies against the bacteria[7].
Alcohol consumption does not cause chronic gastritis. It does, however, erode the gastric mucosa; low doses of alcohol stimulate hydrochloric acid secretion. High doses of alcohol do not stimulate acid secretion[8]. NSAIDs inhibit the constitutional cyclooxygenase-1 (COX-1) enzyme responsible for eicosanoids biosynthesis in the stomach, which increases the chances of the formation of peptic ulcers[9]. Also, NSAIDs, such as aspirin, reduce a protective substance in the stomach called prostaglandin. These drugs taken used short-term are not typically dangerous. However, regular use can lead to gastritis[10].
The immune system makes antibodies and other proteins that fight infections to maintain the body. In some disorders, the body accidentally targets the stomach as a foreign protein or infection. It makes antibodies against and it severely damages or even destroys the stomach and/or its lining[10]. Bile, normally sent to the small intestine to aid in digestion, will sometimes enter the stomach instead, because the pyloric valve does not work properly or it has been removed during surgery. This leads to chronic gastritis. Gastritis may also be caused by other medical conditions, including HIV or AIDS, Crohn's disease, some connective tissue disorders, or liver or kidney failure[11].
Pernicious anemia, a B12 deficiency in the blood, is one disease that is caused by gastritis[12]. Severe gastritis may be is possible when the stomach is viewed without symptoms being present and may be present despite only minor changes in the stomach lining. Seniors have a higher likelihood of developing painless stomach damage. They may have no symptoms at all, such as an absence of vomiting or pain, until they are suddenly taken ill with internal bleeding. Pain in the upper abdomen is the most common symptom. The pain is usually in the upper central portion of the abdomen, the "pit" of the stomach. Gastritis pain can occur in the left upper portion of the abdomen and in the back. The pain seems travels from the belly to the back. The pain is typically vague, but can be a sharp pain. Belching either doesn't relieve pain or only relieves it for a moment. The vomit is either clear, green or yellow, has a bloody streak in it, or is completely bloody, depending on the severity of inflammation. Bloating and a feeling of fullness or burning in the upper abdomen are also signs of moderate gastritis. Severe gastritis presents pallor, sweating, rapid heart beat, feeling faint or short of breath, severe chest or stomach pain, vomiting large amounts of blood, bloody or dark, sticky, foul-smelling bowel movements[13].
Typically, a diagnosis is made based on the patients description of his or her symptoms. If a diagnosis is not possible based on these symptoms, however, other methods are used. Tests for blood cell count, H. pylori, and pregnancy; and liver, kidney, gallbladder, and pancreas functions, may be ordered. Urinalysis may be used, or a stool sample taken, to look for blood in the stool. X-rays may be ordered, as well as ECGs. If none of these tests are able to be used for diagnosis, one may be recommended to a gastroenterologist. He or she may do a endoscopy, where a flexible probe with a camera on the end is sent into one's stomach to check for stomach lining inflammation and mucous erosion. At the same time, a stomach biopsy may be taken to test for gastritis and a variety of other conditions[14].
Over-the-counter antacids in liquid or tablet form are a common treatment for mild gastritis. Antacids neutralize stomach acid and can provide fast pain relief. When antacids don't provide enough relief, your doctor may recommend a medication such as cimetidine, ranitidine, nizatidine or famotidine that helps reduce the amount of acid your stomach produces. An even more effective way to limit stomach acid production is to shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these small pumps. This class of medications includes omeprazole, lansoprazole, rabeprazole, and esomeprazole. Proton pump inhibitors also appear to inhibit H. pylori activity. Cytoprotective agents are designed to help protect the tissues that line your stomach and small intestine. They include the medications sucralfate and misoprostol. If you're taking NSAIDs regularly, your doctor may suggest that you also take one of these medications to protect your stomach. Another cytoprotective agent is bismuth subsalicylate. In addition to protecting the lining of your stomach and intestines, bismuth preparations appear to inhibit H. pylori activity as well. Doctors use several regiments to treat H. Pylori infection. Most use a combination of two antibiotics and a proton pump inhibitor. Sometimes bismuth is also added to the regiment. The antibiotic aids in destroying the bacteria, and the acid blocker or proton pump inhibitor relieves pain and nausea, heals inflammation, and may increase the antibiotic's effectiveness[15].
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