Gastritis is an inflammation of the gastric mucosa; it may be acute or chronic. Acute gastritis, the most common stomach disorder, produces mucosal reddening, edema, and superficial surface erosion. Chronic gastritis is common among elderly people and people with pernicious anemia. It's often present as chronic atrophic gastritis, in which all stomach mucosal layers are inflamed, with a reduced number of chief and parietal cells. Acute or chronic gastritis can occur at any age.
The most frequent cause of gastritis is a dietetic indiscretion such as habitual overeating; eating of badly combined or improperly cooked foods; excessive intake of strong tea, coffee, or alcoholic drinks; or habitual use of large quantities of condiments and sauces.
Other causes include worry, anxiety, grief, and prolonged tension, use of certain drugs, strong acids, and caustic substances.
Signs and Symptoms
The patient history may reveal one or more causative agents. After exposure to the offending substance, the patient with acute gastritis typically reports rapid onset of such symptoms as epigastric discomfort, indigestion, cramping, anorexia, nausea, hematemesis, and vomiting. The patient's symptoms may last a few hours to a few days.
The patient with chronic gastritis may describe similar symptoms, experience only mild epigastric discomfort, or have only vague complaints. For example, the patient may report intolerance of spicy or fatty foods or have mild epigastric pain that is relieved by eating. Patients with chronic atrophic gastritis are often asymptomatic.
On inspection, the patient may appear normal or show such signs of distress as fatigue, grimacing, and restlessness, depending on the severity of symptoms. If gastric bleeding has occurred, he may appear pale and his vital signs may reveal tachycardia and hypotension. Inspection and palpation may disclose abdominal distention, tenderness, and guarding. Auscultation may reveal increased bowel sounds.
Upper GI endoscopy (commonly with biopsy) confirms gastritis when it's performed within 24 hours of bleeding. Biopsy reveals the inflammatory process. If the procedure fails to stimulate acid production, it confirms achlorhydria. In patients with pernicious anemia, gastroscopy fails to reveal the intrinsic factor. This procedure is contraindicated after ingestion of a corrosive agent.
Laboratory analyses can be used to detect occult blood in vomitus or stools (or both) if the patient has gastric bleeding.
Hemoglobin level and hematocrit are decreased if the patient has developed anemia from bleeding.
An immediate therapeutic priority is to eliminate the cause of gastritis. For example, bacterial gastritis is treated with antibiotics and ingested poisons are neutralized with the appropriate antidote. When the associated disease is treated or the offending agent is eradicated or neutralized, the gastric mucosa usually begin to heal.
Treatment for a patient with acute gastritis is symptomatic and supportive. Healing usually occurs within a few hours to a few days after the cause is eliminated. Histamine antagonists, such as cimetidine, ranitidine, or famotidine, may be ordered to block gastric secretion. Antacids, such as aluminum hydroxide and magnesium hydroxide, may be used as buffering agents. Some patients also require analgesics.
When gastritis causes massive bleeding, treatment includes blood replacement; iced saline lavage, possibly with norepinephrine; angiography with vasopressin infused in normal saline solution; and, sometimes, surgery.
Surgery is a last resort, performed only if more conservative treatments fail. Vagotomy and pyloroplasty have been used with limited success. Rarely, partial or total gastrectomy may be required.
Because patients with chronic gastritis may be asymptomatic or have only vague complaints, no specific treatment, except for avoiding aspirin and spicy foods, may be necessary. If symptoms develop or persist, antacids may be taken. If pernicious anemia is the underlying cause, vitamin B12 is administered parenterally.
The mainstay of gastritis prevention is to avoid those things that irritate or inflame your stomach's lining.
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