Gastritis

Gastritis causes abdominal pain, nausea and other symptoms.

Gastritis is inflammation of the lining of the stomach. Unfortunately, the term "gastritis" has been misused to include many different upper abdominal problems, but true gastritis refers to the stomach lining (gastric mucosa) that is inflamed. All or part of the gastric mucosa may be involved.

Gastritis may be classified as acute or chronic:

• Acute gastritis may be characterized as erosive (damaged areas where mucosal cells are disrupted or missing) and nonerosive.
• Chronic gastritis is determined by histopathology (appearance of the gastric mucosa) with symptoms lasting a long time.

There is no widely accepted classification system although some have been proposed.

This information will focus on true gastritis. Gastritis has many causes, but most causes result in similar symptoms. This has led to some confusion and is the reason why many healthcare professionals now consider the term "gastritis" as a non-specific description of a cluster of symptoms.

Most people confuse gastritis with gastroenteritis. However, they are different conditions.

• Gastroenteritis is inflammation (irritation) of the stomach and intestines, which is definitely caused by an infection.
• Gastritis is inflammation of the stomach lining which is specifically and not always caused by an infection.

A major cause of both acute and chronic gastritis is an infection of the stomach mucosa by a bacterial species named Helicobacter pylori. Usually, this bacterium first infects the stomach antrum (stomach mucosa without acid-producing cells) acutely and may progress to infect most or all of the stomach's mucosa over time (chronic gastritis) and remain there for years. This infection generates an initial strong inflammatory response and eventually, a long-term chronic inflammation with intestinal cell changes may develop. Another major cause of acute and chronic gastritis is the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

However, there are many other causes of gastritis; the following is a list of common causes of both acute and chronic gastritis; chronic gastritis may occur with the repeated or continual presence of most of these causes:

• Bacterial, viral, and parasitic infections
• Certain drugs (cocaine)
• Alcohol use (especially if drinking excessive amounts of alcohol)
• Bile reflux
• Fungal infections
• Allergic reactions
• Autoimmune reactions
• Stress reaction
• Radiation
• Certain food poisonings (infectious and chemical)
• Trauma

In general, infectious agents, especially Helicobacter pylori, alcohol use, and NSAIDs are responsible for the majority of people with gastritis.

Gastritis can affect men and women equally. It is more common in adults older than 60 and often appears as Helicobacter pylori gastritis, the most common type of gastritis. You may be more at risk for reactive gastritis if you drink heavily, take NSAIDs, or smoke cigarettes.

People with autoimmune disorders such as celiac disease, type 1 diabetes, Addison's disease, or Hashimoto's disease are at higher risk for developing gastritis.

Many people with gastritis do not have symptoms. The condition is diagnosed only when samples of the stomach mucosa are examined for other suspected diseases. However, when gastritis symptoms occur, the most common symptoms include:

• Abdominal pain (intermittent or constant burning
• Gripping or gnawing pain)
• Nausea and vomiting
• Diarrhea
• Loss of appetite
• Bloating, burping
• Belching

Gastritis symptoms come and go over time, especially with chronic gastritis. Indigestion (dyspepsia) is another term that encompasses this cluster of symptoms. Symptoms of severe gastritis may include:

• Vomiting blood
• Blood in the stool
• Anemia

Gastritis is diagnosed based on the patient's symptoms and history of a previous diagnosis and treatment of gastritis, alcohol consumption, and use of NSAIDs. A definitive diagnosis of gastritis is made by identifying the underlying cause of the gastric mucosal inflammation and/or by tissue (gastric) biopsy. For example, the major infective cause of gastritis is Helicobacter pylori (H. pylori). This bacterium can be detected by breath, blood, stool, immunological, and biopsy tests. Although the bacterium can be cultured from the patient, this is seldom attempted. Other pathogens can be identified using culture, stool, and immunological tests.

Biopsy of the stomach mucosa, done during endoscopy examinations, is often used in patients to identify the causes of chronic gastritis and may allow visualization of mucosal erosions and other stomach mucosal changes. Abdominal X-rays or barium studies (upper or lower) may demonstrate the presence of thickened mucosa and folds that are signs of inflammation in the stomach.

Your doctor can help determine which tests should be done, including ancillary tests that may help identify other causes of the non-specific symptoms commonly found with gastritis.

Treatments for gastritis vary and depend on successful treatments of its underlying cause(s). The most common treatments are over-the-counter (OTC) and prescription medications for symptom relief.

A diet that avoids hot, fried, and/or spicy foods, alcohol drinking, or eating items you may be allergic to is another good way to both treat and reduce the risk of gastritis.

Treating the underlying cause of gastritis is the most effective way to reduce or resolve gastritis symptoms. For example, if the cause of gastritis is H. pylori, then treatment with appropriate antibiotics (usually a combination of amoxicillin and clarithromycin [Biaxin, Biaxin XL] plus bismuth subsalicylate [Pepto-Bismol]) should be effective to provide relief from symptoms.

If NSAIDs are the cause, then stopping the drug should be effective.

Other treatments often are used in addition to those that treat the specific cause of gastritis, many of which are over-the-counter or OTC, which may reduce or stop symptoms of gastritis and allow gastric mucosal healing to begin regardless of the underlying cause. These medications include:

• antacids (Maalox, Rolaids, and Alka-Seltzer)
• histamine (H2) blockers (famotidine [Pepcid AC, Zantac 360])
• PPI's or proton pump inhibitors (omeprazole [Prilosec], pantoprazole [Protonix], esomeprazole [Nexium])

They all function by different mechanisms to reduce acid in the stomach but usually do not treat the underlying cause of gastritis.

Usually, home remedies do not treat the underlying cause of gastritis but they can help prevent it or decrease symptoms (see below).

There are general recommendations about what foods and drinks you should consume to help reduce and relieve symptoms of gastritis. If underlying causes are not treated (for example, severe H. pylori infection, eating spicy foods, and/or alcohol consumption), diet changes may result in little or no change in gastritis symptoms.

Foods and other substances that should be avoided to reduce or prevent gastritis symptoms include alcohol, spicy, fatty, and fried foods. Moreover, anything that might be toxic or irritating to the stomach should also be avoided (for example cigarette smoking, acidic drinks like coffee, garlic powder, chili powder, peppers, and tomato products).

The University of Maryland healthcare professionals and others suggest that eating smaller, more frequent meals and avoiding spicy, acidic, fried, or fatty foods will help reduce symptoms. Moreover, stress reduction is also recommended. Dietary changes such as ginger tea and chamomile tea with honey reportedly soothe gastritis symptoms while onions, garlic, cranberries, apples, and celery may stop H. pylori growth.

Foods that may stop H. pylori growth and relieve gastritis symptoms include:

• Teas (green and white in particular)
• Yogurt
• Peppermint
• Wheat bran
• Carrot juice
• Coconut water
• Green leafy vegetables
• Onions
• Garlic
• Apples
• Fresh fruits and berries
• Celery
• Cranberry juice
• Kale
• Broccoli
• Scallions
• Parsley
• Thyme
• Soybeans
• Soy foods
• Legumes (beans, peas, and lentils)

Although these home remedies may help reduce or soothe symptoms, home remedies seldom treat the underlying causes of gastritis.

Acute gastritis lasts for about 2-10 days. If chronic gastritis is not treated, it may last from weeks to years.

Most people who get gastritis have few short-term symptoms, recover completely, and are cured of the condition. Those people with underlying causes that are appropriately treated often recover completely. The prognosis of individuals with chronic disease and those who develop serious complications like bleeding ulcers, obstruction, and cancer.

The complications of gastritis may occur over time, especially if gastritis becomes chronic and the underlying causes are not treated.

Complications of gastritis may include:

• Peptic ulcer
• Bleeding ulcers
• Erosive stomach lining (the stomach tissue wears away)
• Anemia
• Gastric cancers
• MALT lymphoma
• Gastric scarring and strictures with outlet obstruction
• Dehydration
• Kidney problems
• Death (usually due to bleeding)

Other complications may include:

• Peptic ulcer disease: This causes painful sores in the upper digestive tract.
• Gastric polyps: These are small masses of cells that form on the inside lining of the stomach.
• Stomach cancer: They can be aggressive or nonaggressive. Gastritis due to H. pylori infection increases the risk of stomach cancer.
• Atrophic gastritis: This can happen if gastritis is caused by H. pylori bacteria or by an autoimmune disorder. Atrophic gastritis destroys the stomach lining cells that make digestive juices. This increases the risk of getting stomach cancer. It can also cause low levels of certain vitamins in the blood.

If the underlying cause of gastritis is preventable, then gastritis can be prevented and people can get gastritis relief.

• Don't drink alcohol, take NSAIDs, and quit smoking if they trigger gastritis.
• Avoid situations where chemicals, radiation, or some toxin ingestion could be.
• It may be more difficult to prevent some infectious causes of gastritis, but proper hygiene, hand washing, and eating and drinking only adequately cleaned or treated foods and fluids are healthy ways to decrease your risk of getting gastritis from infectious agents.