Gastritis

Gastritis is inflammation of the stomach lining due to irritation of the tissues. The condition may be acute or chronic. Acute gastritis may be due to infection with the Helicobacter pylori bacterium. It may also be caused by drugs, usually nonsteroidal anti-inflammatory drugs such as aspirin; alcohol; or severe physical stress, such as burns or major surgery.

Chronic gastritis is most often due to Helicobacter pylori (HP) infection but may be due to prolonged irritation by smoking, alcohol, or bile; by an autoimmune disorder that damages the stomach lining ; or by degeneration of the lining with age.

Symptoms include discomfort in the upper abdomen, nausea, and vomiting. In acute gastritis, the faeces may be blackened by blood lost from the stomach; in chronic gastritis, slow blood loss may lead to anaemia , resulting in symptoms such as pallor, tiredness and breathlessness.

Diagnosis of gastritis is made through gastroscopy (examination of the stomach lining with a flexible viewing instrument), during which a biopsy (removal of a tissue sample for analysis) may be performed.

Ulcer-healing drugs and antibiotics may be prescribed to treat Helicobacter pylori infection. Anaemia will be treated. There is no treatment for gastritis due to an autoimmune disorder, however.

Gastritis in greater detail

Gastritis is inflammation of the stomach lining. The characteristic symptom of gastritis is a burning sensation or discomfort at the top of the abdomen. This area is known medically as the epigastrium. Sometimes the burning sensation can also be present in the lower chest.

The symptoms of gastritis and gastro-oesophageal reflux disease can be similar, but generally the burning sensation, pain and discomfort is felt lower with gastritis than with gastro-oesophageal reflux disease. Sometimes gastritis can cause heartburn, nausea, indigestion (or dyspepsia), loss of appetite, hiccups and belching. In severe cases gastritis causes severe epigastric burning pain, vomiting and even bleeding from the stomach lining.

If the stomach lining bleeds, then this can manifest itself as vomiting with blood present, coffee ground vomit or melaena.

NOTE: Melaena is black, tarry, offensive, and usually liquid stools. Melaena is a medical emergency and if you suspect this symptom then you should seek medical advice immediately.

Sometimes the bleeding from the stomach lining can be asymptomatic and if it continues for some time ( usually weeks or months) then the result is anaemia.

Gastritis can be caused by drugs such as aspirin, steroids such as prednisolone and dexamethasone, non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and diclofenac, and SSRI antidepressants such as fluoxetine and citalopram.

Other causes of gastritis include alcohol, bile, cocaine, ischaemia, acute stress,severe illness, radiation, allergy and food poisoning and direct trauma.

Gastritis often results as a result of an infection the stomach lining by the bacterium Helicobacter pylori. This bacterium can also cause stomach ulcers and duodenal ulcers. Chronic gastritis is common amongst the elderly population, and this is quite often linked to the use of non-steroidal anti-inflammatory drugs taken for joint pains and arthritis.

Food causes: alcohol is a potent irritant of the stomach and regular drinking, especially to excess can lead to gastritis. Strong alcoholic drinks such as whiskey and vodka are particularly likely to cause gastritis. Eating rich spicy foods, particularly curries and food containing chilli on a daily basis, particularly at night can lead to gastritis. If you think you are suffering from gastritis you should consult a doctor. If you have gastritis then you should avoid potential irritants such as strong tea or coffee and meat extracts. You should also avoid spicy foods, curries and foods containing chilli. It is also sensible to let food and drinks cool down before consumption. Studies have shown that drinking very hot drinks such as hot tea or coffee can lead to gastritis or peptic ulcers. It is also sensible to cut down on acidic foods such as vinegar and citrus fruits. Other foods that might aggravate gastritis include onions, radishes, fatty foods, fried foods and unripe fruits.

When a diagnosis of gastritis has been made, some dieticians recommend an initial diet of water (to remove toxins from the body and allow the stomach lining to heal), bananas for energy and potassium, plain boiled white rice as a low fibre carbohydrate, apples for their cleansing action, and dry toast to provide bland bulk. All other foods should be avoided for the first 48 hours. It is then sensible to continue with a bland diet until you are certain that the symptoms of gastritis have resolved completely.

Chamomile tea (allowed to cool) and licorice may help to soothe the stomach and ease some of the symptoms. Medication for gastritis includes antacids for immediate relief.

Examples of antacids include: magnesium trisilicate, aluminium hydroxide (Maalox), hydrotalcite, Asilone, Gaviscon, Peptac, Gastrocote, Rennie’s, Topal, and Tums. More potent drugs which reduce the amount of acid secreted by the stomach lining are generally advised. These drugs are known as histamine H2-receptor antagonists. They include: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid).

More potent drugs, known as proton pump inhibitors (PPI’s) are even more effective at treating gastritis. Examples of PPI’s include: omeprazole (Losec), lansoprazole (Zoton), esomeprazole (Nexium), pantoprazole (Protium) and rabeprazole (Pariet). Other drugs that are sometimes used include: sucralfate (Antepsin), tripotassium dicitratobismuthate (De-Noltab), and misoprostol (Cytotec).

Acute erosive or haemorrhagic gastritis

Acute gastric erosions are breaches in the stomach lining (gastric epithelium) which are often multiple and very small. In other words less than 3 mm in size. The are caused by an acute diffuse response to a gastric irritant or insult. If the erosions penetrate deeper into the stomach lining, (through what is known as the muscularis mucosa) then they become acute gastric ulcers. Most acute gastric ulcers are now associated with helicobacter pylori, severe illness, severe stress or ingestion of non-steroidal anti-inflammatory drugs (NSAIDS) or alcohol. Acute gastric erosions or ulcers due to ingested substances or medications.

Non-steroidal anti-inflammatory drugs which include aspirin, ibuprofen, naproxen, diclofenac and meloxicam cause acute gastric erosions or ulcers by inhibiting the synthesis of protective prostaglandins by cyclo-oxygenase-1. The result is impaired mucosal protection caused by reduced mucosal blood flow and reduced secretion of bicarbonate and mucus. Alcohol causes acute gastritis, gastric erosions and gastric ulceration by a direct toxic effect.

Diagnosis of gastritis, gastric erosions and gastric ulcers (stomach ulcers).

The diagnosis is suggested by the history of epigastric pain and the above listed symptoms. However gastritis and gastric ulcers can be symptomless. The diagnosis is easily made with a gastroscope or endoscope. This is a fibre-optic tube which is inserted through the mouth and enables the specialist gastroenterologist to view the lining of the stomach directly. Gastritis, gastric erosions and gastric ulcers have a typical appearance via an endoscope.

Gastritis is easily treated by following the correct diet, avoiding gastric irritants and by taking medication such as antacids, cimetidine, ranitidine or PPI’s. Gastritis usually improves over a period of a few days but may take four to six weeks to heal completely.