Gastritis

Gastritis is a term used to describe a group of conditions characterized by inflammation of the lining of your stomach. Commonly, the inflammation of gastritis results from infection with the same bacterium that causes most stomach ulcers. Yet other factors including traumatic injury and regular use of certain pain relievers also can contribute to gastritis.

Gastritis may occur suddenly (acute gastritis) or it can occur slowly over time (chronic gastritis). In spite of the many conditions associated with gastritis, the signs and symptoms of the disease are very similar: a burning pain in your upper abdomen and occasionally, bloating, belching, nausea or vomiting.

In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis is not serious and improves quickly with treatment.

Symptoms
The signs and symptoms of gastritis include:

A gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better when you eat
Nausea
Vomiting
Loss of appetite
Belching or bloating
A feeling of fullness in your upper abdomen after eating
Weight loss

Acute gastritis occurs suddenly and is more likely to cause nausea and burning pain or discomfort in your upper abdomen. Chronic gastritis develops gradually and is more likely to cause a dull pain and a feeling of fullness or loss of appetite after a few bites of food. For many people, though, chronic gastritis causes no signs or symptoms at all.

Occasionally, gastritis may cause stomach bleeding, but it is rarely severe. But be aware that bleeding in your stomach that causes you to vomit blood or pass black, tarry stools requires immediate medical care.

Causes

Gastritis usually develops when your stomach's protective layer becomes overwhelmed or damaged. A mucus-lined barrier protects the walls of your stomach from the acids that help digest your food. Weaknesses in the barrier allow your digestive juices to damage and inflame your stomach lining.
A number of factors can contribute to or trigger gastritis, including:

Bacterial infection. People infected with Helicobacter pylori (H. pylori) can experience gastritis most commonly chronic gastritis. Half the world's population is thought to be infected with the bacterium, which passes from person to person. But the majority of those infected do not experience any complications of H. pylori infection. In some people, H. pylori may break down the stomach's protective coating, causing changes in the stomach's lining. The reason why some people experience complications from H. pylori infection and others do not is not clear. However, doctors believe vulnerability to the bacterium could be inherited from your parents or it could be caused by your lifestyle, such as smoking and high stress levels.

Regular use of pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), can cause both acute gastritis and chronic gastritis. Using these drugs regularly or taking too much of these drugs may reduce a key substance that helps preserve the protective lining of your stomach. Stomach problems are less likely to develop if you take NSAIDs only occasionally.

Excessive alcohol use. Alcohol can irritate and erode your stomach lining, which makes your stomach more vulnerable to digestive juices. Excessive alcohol use is more likely to cause acute gastritis.

Stress. Severe stress due to major surgery, traumatic injury, burns or severe infections can cause acute gastritis.

Bile reflux disease. Bile — a fluid that helps you digest fats — is produced in your liver and stored in your gallbladder. When it is released from the gallbladder, bile travels to your small intestine through a series of thin tubes. Normally, a ring-like sphincter muscle (pyloric valve) prevents bile from flowing into your stomach from your small intestine. But if this valve does not work properly, or if it has been removed because of surgery, bile can flow into your stomach, leading to inflammation and chronic gastritis.

Your own body attacking cells in your stomach. Called autoimmune gastritis, this rare condition occurs when your body attacks the cells that make up your stomach lining. This produces a reaction by your immune system that can wear away at your stomach's protective barrier. Autoimmune gastritis is more common in people with autoimmune disorders, including Hashimoto's disease, Addison's disease and type 1 diabetes. Autoimmune gastritis can also be associated with vitamin B-12 deficiency, which can be harmful.

Other diseases and conditions. Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn's disease, parasitic infections, some connective tissue disorders and liver or kidney failure.

Tests and diagnosis
Although your doctor is likely to suspect gastritis after talking to you about your medical history and performing a thorough exam, you may also have certain tests to pinpoint the exact cause. These tests include:

Blood tests. Your doctor may order a blood test to check for the presence of H. pylori antibodies. A positive test shows that you've come in contact with the bacteria at some time in your life, but it does not necessarily indicate current infection. Blood tests can also check for anemia, which may result from stomach bleeding associated with gastritis.

Breath test. This simple test can help determine whether you are currently infected with H. pylori bacteria.

Stool tests. This test checks for H. pylori in a sample of your stool. A positive test suggests current infection. Your doctor may also test for the presence of blood in your stool, a sign of stomach bleeding that can accompany gastritis.

Upper gastrointestinal endoscopy. This procedure allows your doctor to see abnormalities in your upper gastrointestinal (GI) tract that may not be visible on X-rays. For the test, your doctor inserts a thin, flexible, lighted tube (endoscope) through your mouth and into your esophagus, stomach and the first part of your small intestine. Your throat is usually numbed before you swallow the endoscope, and you will receive additional medication to ensure that you are comfortable during the procedure. If any tissue in your upper intestinal tract looks suspicious, your doctor can remove a small sample (biopsy) using instruments inserted through the endoscope. The sample is then sent to a lab for examination by a pathologist. Upper endoscopy takes about 20 to 30 minutes, although you would not be sent home until the medication wears off usually one to two hours later. Risks of the procedure are rare and include bleeding and perforation of the stomach lining. The most common complication is a slight sore throat from swallowing the endoscope.

Upper gastrointestinal X-ray. These X-rays of your stomach and small intestine check for signs of gastritis and other digestive problems. They are often taken after you swallow a liquid (barium) that coats the lining of your digestive tract, making it show up more clearly on the X-rays.

Treatments and drugs
Treatment of gastritis depends on the specific cause. Acute gastritis caused by NSAIDs or alcohol may be relieved by stopping use of those substances. Chronic gastritis caused by H. pylori infection is treated by eradicating the bacteria. Most gastritis treatment plans also incorporate medications that treat stomach acid in order to reduce signs and symptoms you're experiencing and promote healing in your stomach.

Medications to treat stomach acid
Stomach acid irritates inflamed tissue in your stomach, causing pain and further inflammation. That is why, for most types of gastritis, treatment involves taking drugs to reduce or neutralize stomach acid, such as:

Antacids. Over-the-counter antacids (Maalox, Mylanta, others) in liquid or tablet form are a common treatment for mild gastritis. Antacids neutralize stomach acid and can provide fast pain relief.

Acid blockers. When antacids do not provide enough relief, your doctor may recommend a medication, such as cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) or famotidine (Pepcid), that helps reduce the amount of acid your stomach produces.

Medications to shut down acid 'pumps.' Medications called proton pump inhibitors reduce acid by blocking the action of tiny pumps within the acid-secreting cells of your stomach. This class of medications includes omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium).

Medications to treat H. pylori
Doctors use several regimens to treat H. Pylori infection. Most use a combination of two antibiotics and a proton pump inhibitor. Sometimes bismuth (Pepto-Bismol) is added to the mix. The antibiotics help destroy the bacteria, and the proton pump inhibitor relieves pain and nausea, heals inflammation and may increase the antibiotics' effectiveness.

To ensure that H. pylori has been eliminated, your doctor may test you again after treatment.

Prevention
Although you can not always prevent H. pylori infection, these suggestions can help reduce your risk of gastritis:

Eat smart. If you experience frequent indigestion, eat smaller, more frequent meals to help ease the effects of stomach acid. In addition, avoid any foods you find irritating, especially those that are spicy, acidic, fried or fatty. While taking these steps can reduce the signs and symptoms you experience, they can not prevent gastritis.

Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining of your stomach, causing inflammation and bleeding.

Do not smoke. Smoking interferes with the protective lining of the stomach, making your stomach more susceptible to gastritis as well as ulcers. Smoking also increases stomach acid, delays stomach healing and is a leading risk factor for stomach cancer. Still, stopping is not easy, especially if you have smoked for years. Talk to your doctor about methods that may help you stop smoking.

Switch pain relievers. If possible, avoid taking NSAIDs — aspirin, ibuprofen and naproxen. These over-the-counter medications can cause stomach inflammation or make existing irritation worse. Instead, switch to pain relievers containing acetaminophen.

Follow your doctor's recommendations. Your doctor may recommend that you take an over-the-counter antacid or acid blocker to help prevent recurring gastritis.

Complications
Left untreated, gastritis may lead to stomach ulcers and stomach bleeding. Some forms of chronic gastritis may increase your risk of stomach cancer, especially if you have extensive thinning of the stomach lining and changes in the lining cells.
Tell your doctor if your signs and symptoms are not improving despite treatment for gastritis.

Dr. Benjamin Sinappan
Director – Medical Services
Occupational Health Physician

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The information is provided in good faith and not meant to be the basis for treatment or management. All treatment and management must be done with the advice and under the directly supervision of a qualified medical doctor. PMCare or its office bearers take no responsibility for the accuracy or inaccuracy of the information provided and will not be liable for any consequences