Gastritis is a widespread condition among the population worldwide. Please enter here to acquire key insights from a doctor.
The article will touch both acute and chronic gastritis for a full comprehension of the topic; however, the main subject of this article would be acute gastritis.
What is and how functions the stomach?
The stomach is one of the core organs of the digestive tract for the body to prepare food for absorption. Its main task is to degrade food by acid secretions, for then the intestines do its job of incorporating the nutrients that unpin from this process. The regulation of this fragile method requires the active participation of the hormones, and nerves either locally or from vital structures within the skull.
Another critical element is the division of the stomach. This medical division explains what possible disease is affecting the stomach, symptoms, complications, or even treatment. Right before the stomach, there is the esophagus, and after it, the direct continuation is with the duodenum, which is the first portion of the small bowel. The cardia is the red portion in the image, the fundus is the purple, the body is blue, and the pylorus is yellow, and the green one is the pyloric sphincter. This division exists because diseases tend to affect different portions of the stomach, so to know them is fundamental.
One cell type in the stomach secretes acid, the parietal cells, and they are in regulation by multiple sources. The acid is thought to eliminate any bacterium that could colonize and infect the stomach lining, besides decomposing the food into smaller pieces. The mechanisms of the stomach to counterbalance the gastric acid levels are exceptional. It consists of a mucous layer called gastric mucosa that has plenty of mucus and bicarbonate that neutralizes that acid level. If this layer fails to do the job, probably the acid would perforate gastric walls as it does with food. That is why any imbalance of both factors converts into a gastric disease.
What is gastritis?
Gastritis is the inflammation of the stomach lining. The inflammation level is not in a strict correlation with symptoms; therefore, having worse inflammation does not necessarily mean that you would get more acute symptoms.
In fact, it is pretty common that most patients with gastritis do not have symptoms at all. The interaction between many factors would give us that answer; let’s keep reading.
What is the medical definition of gastritis?
The inflammation of the stomach lining can be found in different ways, as we are going to see in the diagnosis section. However, the exact medical definition of gastritis is when inflammation markers appear within a stomach sample or biopsy; this standard interpretation would need a microscope and special preparation of the tissue. Of course, the doctor has other ways to assume that you have gastritis, like gastritis symptoms or medical procedures, but only with that biopsy study can properly be gastritis in the medical world.
Then, the doctors also divide and classify gastritis according to its time, location, cause, stomach lining appearance, and severeness of the illness. Regarding the time classification, it has acute or chronic presentations, and both of them are also subclassified to concur with its possible causes. Gastritis can affect the whole stomach, or specific portions of it, that give different names as pangastritis or antral/cardial gastritis, respectively.
Acute gastritis has two main categories as erosive and nonerosive gastritis. The erosive gastritis is the one caused mostly by ulcers, which are discontinuation of the stomach lining; basically, ruptures of the healthy tissue which can contain blood. On the contrary, the nonerosive one is mainly by an infection of a unique microorganism, Helicobacter pylori.
Chronic gastritis classification is mainly based on the direct cause, and changes on the cells of the stomach lining that is a broad list.
What causes acute gastritis?
Several factors can cause acute gastritis, such as drugs, consumption of strong liquors, reduced blood flow to the stomach, infection, stress, exposure to radiation, allergy and food poisoning, or direct trauma.
Most of the erosive conditions come from alcohol and nonsteroidal anti-inflammatory drugs (NSAID)/ pain killers. The most frequent NSAID affecting the stomach are aspirin, ibuprofen, and naproxen. An example of non-erosive gastritis is the one caused by Helicobacter pylori infection, most commonly located in the antrum of the stomach.
All these triggers will cause an imbalance between the usual stomach mechanisms of protection on behalf of their offenders. Please remember the means of protection from the digestive juices, which is a layer of mucus with bicarbonate embedded within.
For example, the pain killers in their beneficial function of relieving pain, they reduce the synthesis of a molecule called prostaglandin, which is essential for the production of the healthy mucus that protects from the acid. Therefore, chronic consumption of these drugs would result in an imbalance of the stomach function. The same with the Helicobacter pylori infection, this bacterium capacity to eliminate the stomach acid on its surrounding, allow many bacteria to reach the stomach lining and reside within for long periods.
You may want to see: Gastroenteritis
What causes chronic gastritis?
The classification comprises infectious or noninfectious conditions depending if there is an infective microorganism involved or not, correspondingly. The infectious causes are the most common due to one particular reason. The same bacteria involved in acute gastritis, H. pylori, it also manages to persist and convert into chronic gastritis. This bacteria, when infects for the first time, causes an acute episode, but as I said, it has tremendous mechanisms of surviving. Therefore, it is also a prevalent cause of chronic gastritis in the whole world. The estimation is that half of the world carries this microorganism.
Other germs can prompt other expressions of gastritis as granulomatous gastritis, which is rare. Many types of microorganisms can cause the infection, including bacteria, fungi, parasites, even viruses (as the herpes virus.)
The noninfectious triggers comprise an extensive list, including internal and external factors. Nevertheless, in chronic gastritis, the autoimmune disorder plays a leading role, which is a dysregulation of the immune system. The system recognizes and attacks healthy molecules of the body that was supposed to protect from outsiders. Yes, the immune system stops combating foreign and harmful molecules and starts doing so to its own, causing inflammation. Types of chronic gastritis as eosinophilic gastritis or autoimmune gastritis, are an expression of it. Furthermore, autoimmune diseases affecting the whole body can also have an impact on the stomach; for that, the patient must always have a complete assessment. It is worth to tell that the accurate differentiation between them requires an exhaustive study by your doctor.
Is gastritis the same as gastropathy?
Gastropathy means that a nocive factor is damaging the smallest structures of the stomach (cells). If there is inflammation in this scenario, it is minimal. On the contrary, as we said before, the strict definition of gastritis comprises only inflammation, not damage (even though it can cause it too). Therefore, gastropathy is a different condition because there is no inflammation, and in gastritis, the inflammation is critical, plus that it can cause harm to cells. And even though they are no the same are often confused one for another.
Possibly this problem comes from the fact that the factors that cause damage could also prompt inflammation, like drugs. However, differentiating between them is essential because they do not carry the same risk in the long term.
What are the risk factors for acute gastritis?
The patients portraying any of these factors in a typical relationship with gastritis are keener to develop the condition. The elements are either in association with lifestyle or are preceding diseases, and the list includes smoking cigarettes, consumption of alcohol, using drugs as NSAIDs or steroids, allergies, previous stomach lining injury, eating raw fish, and gall bladder disorders.
What are the gastritis symptoms?
There are no specific symptoms for this condition. However, some descriptions of how are the most common presentations are available. Acute gastritis tends to present with stomach pain or abdominal pain (see the image), heartburn, nausea, and vomiting. Most of the people could remain asymptomatic with minor symptoms and progress to chronic gastritis. The mild symptoms include abdominal discomfort located high and to the left of the abdomen, and others that may accompany are loss of appetite, belching, and bloating.
Nevertheless, the presentation of severe gastritis with unbearable symptoms could exist. One of them, which is also rare, is phlegmonous gastritis, and it is a severe infection by bacteria of the stomach that carries a high chance of dying. This condition mostly exists in people with predisposing risk factors as a weakened immune system.
How would I know that gastritis will go away?
The symptoms described before as the pain or burning in the abdominal area could also present with nausea and vomiting. These symptoms may improve or worsen with eating. This improvement would depend on the previous history of the patient or which was the source of the pain initially. So, there is a previous gastric disease? Possible ingestion of food with bacterial toxins happened? The patient routinely takes pain killers or recently took high doses?
In light of this, there is no specific treatment except when it is by Helicobacter pylori that have a specific antimicrobial therapy. The complete eradication of the infection through a triple therapy, including antibiotics and gastric protectors, usually have successful results. Also, the identification of the trigger allows people to discontinue them as alcohol or pain-killers. This measure would decrease the harm in the stomach and aid in making gastritis go away.
What are the possible complications of gastritis?
The complication of acute gastritis comprises internal bleeding, which can manifest as vomiting blood, intestinal obstruction, severe dehydration, and kidney damage—all of them threatening to life conditions if not adequately managed.
Chronic gastritis is a little more complex regarding complications. It would depend on the underlying cause, which can be widely different. The H. pylori infection, for example, could end in peptic ulcer or gastric cancer. The peptic ulcer disease comprises two types, intestinal and gastric ulcer, and it happens in nearly ten percent of the people with this bacteria. Before stomach cancer, there are changes in the healthy stomach tissue to abnormal as atrophic gastritis. These changes are considered a previous step for developing cancer, and it occurs throughout many years stepwise.
Autoimmune gastritis also has distinct complications. The destruction of the gastric cells and chronic stomach inflammation ultimately causes a decrease in the acid secretion, gastric cancer, and a condition called “pernicious anemia.” This anemia is different than just low hemoglobin because there is a lack of an intrinsic factor that is produced in the stomach, which helps the body to absorb necessary compounds in the diet for the hemoglobin could be formed. Therefore, it needs a special assessment and treatment, and precisely the intrinsic factor is a part of it.
How your doctor diagnose this acute condition?
It is not uncommon to see gastritis diagnose solely by a history and body exam assessment. What does this mean? That your doctor would ask all the possible risk factors, and after identifying them. He would start evaluating your abdomen and looking for any signs of severity that would require more attention. This evaluation is critical because gastritis could resemblance other conditions that require urgent surgical interventions (as phlegmonous gastritis).
Nevertheless, the definitive diagnostic is through an upper endoscopy procedure with biopsy. Given that, gastritis is a histologic term, which means that this inflammation can only be seen through a microscope with the tissue prepared in a special tint. If infection by Helicobacter pylori is the problem, and it is present in the stomach, other measures exist, such as stool tests and breath tests; these are no invasive tests and give accurate results detecting the bacteria most of the times.
What is the best treatment for gastritis?
The specific treatment exists only for the H. pylori infection and will be a matter of discussion in the next question. Therefore, if that infection is ruled out, then, a standard therapy for reducing symptoms and complications starts.
Firstly, If the patient is vomiting, then liquid and electrolytes reposition through the mouth or vein depending on the severity is an indication, respectively. Nevertheless, it is not going to help with the symptoms. Secondly, it is logical to think that if something is causing you trouble. The stop of it would be stepwise to relieving it. So let’s start with that, right? The avoidance of all the possible triggers as alcohol or pain killers is essential for the symptoms to decrease in intensity. Thirdly, the medication to reduce acid production in the stomach is vital for reducing symptoms, and it includes antacid, H2 blockers, and proton pump inhibitors.
How do you get rid of an H pylori infection?
The triple therapy for this specific bacteria comprises a variation of two antibiotics and one drug to decrease stomach acidity. It is done this way because it has the best eradication results for now.
Therapy includes as a first drug a proton pump inhibitor or bismuth-based drug, the second drug is clarithromycin, and the third one could also vary, it can be either metronidazole or amoxicillin. If this treatment fails, there is quadruple therapy, but as there are more drugs, even more, side effects, and complications, hence, it is the last resource treatment.
This therapy would need subsequent exams to assure that, indeed, it was eradicated. The treatment with fluids, mainly if the patient is vomiting, also applies in this case.
I think I have it what should I do?
This tool is an acute gastritis symptoms checker that will help you to assess how likely it is that your symptoms are by this condition. Please, feel free to use it as much as you want. It is free and would only take a few minutes.