Substances like anti-inflammatories, aspirin, Helicobacter pylori or alcohol can irritate your gastric mucosa, causing stomach pain, nausea or loss of appetite. Learn how to avoid gastritis.
- 1 What is gastritis, causes, and symptoms
- 2 What is and causes of acute gastritis
- 3 Symptoms of acute gastritis and diagnosis
- 4 Treatment of acute gastritis
- 5 What is chronic gastritis and types
- 6 Symptoms and diagnosis of chronic gastritis
- 7 Treatment of chronic gastritis
- 8 Special types of gastritis
- 9 Recommended diet in patients with gastritis
What is gastritis, causes, and symptoms
The gastritis is an inflammation of the gastric mucosa, which is the layer of cells lining the stomach inside protecting acidity of gastric juices. Although not correct, the term gastritis is often used synonymously with dyspepsia (pain or discomfort in the upper abdomen, as well as symptoms of burning, pressure or fullness often related, but not necessarily, with meals).
Gastritis can be caused by multiple causes: alcohol, tobacco, food, drugs (non-steroidal anti-inflammatory drugs), major surgeries, or infections (Helicobacter pylori bacteria are related to some types of gastritis). Since the end of the 20th century, H. pylori has been associated with gastric disease in one form or another. That is to say, the implication of this bacterium in the gastroduodenal ulcer and as the precursor of some type of gastric cancer is undoubted, but also plays an important role as the cause of gastritis. In fact, when its prevalence has been studied, more than half of the population presents data confirming the presence of this germ in the stomach.
The symptoms are very variable since each individual can experience them in a different way. The most frequent are stomach discomfort or pain, nausea, vomiting, belching, burning, or the presence of blood in the vomit or stool.
The diagnosis of gastritis is histological, ie it is necessary to perform a gastroscopy and obtain a sample of the gastric mucosa by biopsy so that it can be analyzed. Therefore, the diagnosis of gastritis is not only clinical (it is not based only on the symptoms) but it is necessary to perform invasive tests (gastroscopy and biopsy) to confirm its existence.
Generally, the treatment of gastritis includes antacids and other medicines that help to decrease the acidity in the stomach, thus relieving symptoms and favoring the cure of the irritation of your wall. If gastritis is related to a disease or infection, that problem will also be treated.
Finally, patients are advised to make changes in their diet, avoiding certain types of food, beverages or drugs that may cause irritation of the stomach wall.
The classification of gastritis is complex, but by way of the summary can be said to be divided into acute, chronic, and special forms of gastritis. Below we will see the characteristics in terms of causes, symptoms, and treatment of each one of them.
What is and causes of acute gastritis
The main form is acute erosive or hemorrhagic gastritis, which is characterized by erosions in the wall of the stomach that affect only the mucosa. However, there are other forms of acute gastritis that are not hemorrhagic and are due to other causal factors.
Acute gastritis can be produced because of different causes:
- Stress Gastritis: Patients with severe illnesses (polytrauma, large burns, intracranial hypertension …), specifically those admitted to intensive care units, may have ulcers or erosions that often manifest as bleeding. These lesions are caused by multiple causes, including acidic hypersecretion of the stomach and loss of the defensive mechanisms of the gastric mucosa. Although less frequent, in these critical patient units or those with processes that cause blood loss or low blood pressure such as some serious infections ( sepsis ), they may present gastritis due to low blood perfusion, by a decrease of the irrigation of the stomach.
- Toxic gastritis: anti-inflammatories, alcohol, cocaine, caustics, enzymes produced by the pancreas, bile reflux. All these factors, through different mechanisms, cause an increase in the secretion of the gastric acid superior to that the own cells of the mucosa can tolerate, producing the irritation of this one.
- Gastritis produced by Helicobacter pylori, which is a bacterium that infects the mucosa of the stomach producing sometimes ulcers or some types of gastritis. In many cases, infected people never develop any symptoms.
There is other infectious gastritis, less recognized, such as those caused by cytomegalovirus, HIV, some bacteria such as E Coli, and respiratory viruses. They are usually part of more general syndromes, not just gastric.
Symptoms of acute gastritis and diagnosis
The symptoms of acute gastritis vary greatly from one person to another, and in many cases, the patients remain asymptomatic. The most frequent are abdominal pain, nausea, vomiting, loss of appetite, dyspepsia (pain, discomfort or sensation of gastric fullness, more frequent in gastritis caused by H. pylori) and, in the most severe cases, digestive hemorrhage (vomiting with Blood or blackish, such as “coffee grounds,” or black, sticky, smelly stools called “man’s”). Occasionally, this digestive hemorrhage can be very subtle, manifesting itself only through mild anemia due to the small blood loss that occurs.
The pain of dyspepsia typically increases with meals by increased production of gastric acid, while it usually calms with products like dairy and digestive rest.
Diagnosis of acute gastritis
Clinical history and blood analysis (where anemia can be seen) help to suspect acute gastritis, but the diagnosis of confirmation of it is histological, ie, it is necessary to analyze in the microscope a sample of stomach tissue obtained by a Gastroscopy. In this sample, erosions are observed that affect only the mucosa and do not affect deeper layers of the stomach wall.
In addition, by gastric mucosal gastroscopy, a determination of H Pylori can be made through a rapid chemical reaction to obtain a result in minutes.
Gastrointestinal transit with contrast (via a barium slurry) is currently not used except in exceptional cases.
Treatment of acute gastritis
There are different options for the treatment of acute gastritis. Sometimes it is not necessary to treat them since gastritis can be resolved spontaneously. First, it is important to avoid irritating foods ( coffee, tea, alcohol, pepper, mustard, vinegar …) or substances that can damage the gastric mucosa, such as anti-inflammatories. It is advisable to fractionate the meals in a smaller quantity avoiding the fullness, as well as to avoid very elaborate stews that invite to a hiperproducción of acid gastric (cooked, fabada, et cetera). As for anti-inflammatories, in case it is essential to administer them, it will be done after meals (never fasting) and protected by omeprazole.
Drugs that can be used to prevent the onset of gastritis and treat it are antacids, H2 antagonists (which decrease acid secretion from the stomach), or sucralfate. At present and for decades, the first line of treatment for dyspepsia is proton pump inhibitors, highlighting omeprazole, pantoprazole, rabeprazole, lansoprazole, and esomeprazole. These drugs maintain a pH in the stomach not excessively acid, thus reducing the symptoms of gastritis and facilitating healing.
Antacids with antiH2 (ranitidine) or antacids may occasionally be combined with proton pump inhibitors (omeprazole).
In cases where H Pylori is present, the treatment of these acute gastritis should consist of triple therapy with omeprazole or some other proton pump inhibitor plus two antibiotics (amoxicillin and clarithromycin in most cases).
Gastritis improves the situation of the patient does, the lesions disappear within 48 hours of the aggression. When complications such as digestive hemorrhage appear, a gastroscopy may be necessary, although most of the time the bleeding subsides spontaneously without the need for invasive tests. Surgery (which usually involves the removal of the entire stomach) has a very high mortality rate and should only be used as a last resort
What is chronic gastritis and types
The chronic gastritis is a chronic inflammation of the stomach lining that initially affects superficial and glandular mucosal areas, progressing to glandular destruction (atrophy) and metaplasia (the metaplasia term intestinal indicates the conversion of the stomach glands in other Similar to those of the small intestine). In this way, superficial gastritis is transformed into atrophic gastritis.
Types of Chronic Gastritis and Symptoms
The incidence of chronic gastritis increases with age, being more frequent in the elderly than in young people. There are several types of chronic gastritis:
- Gastritis type A or fundic: it is quite rare. In this type of gastritis, the inflammation mainly affects the body and the fundus, which are the upper and middle portions of the stomach. It can cause pernicious anemia – a type of anemia produced by a deficiency of vitamin B 12– since one of the most common causes of pernicious anemia is the weakening of the wall of the stomach (atrophic gastritis). It is frequent that when doing a blood analysis to these patients are observed in the blood antibodies against the parietal cells of the stomach and against the intrinsic factor (a substance produced by the cells of the stomach that allows the absorption in the intestine of vitamin B 12 ), Suggesting that this disease has an autoimmune basis . This type of gastritis predisposes you to an increased risk of developing stomach cancer (adenocarcinoma).
- Gastritis type B: is the most frequent. It affects the antrum (lower portion of the stomach, near the pylorus) in young people or the whole of the stomach in the elderly. It appears in almost all the population older than 70 years and is produced by the chronic infection by H. pylori bacteria. This type of gastritis also predisposes to an increased risk of cancer (mainly intestinal type adenocarcinoma and MALT lymphoma).
In some more recent classification, it has been postulated that chronic gastritis could be divided into:
- Atrophic gastritis (in which process the immunological alterations of Gastritis type A are involved).
- Non-atrophic gastritis (which would be the equivalent of type B, with H. pylori prominence).
- Other special gastritis (which would include chemical causes, those after radiotherapy, those related to diseases such as Crohn’s disease or celiac disease, eosinophilic due to food allergies, and some infectious).
Symptoms and diagnosis of chronic gastritis
In general, the symptoms of chronic gastritis do not differ essentially from acute gastritis regardless of its main cause. In this way, they can go undetected in some cases, without symptoms and only be diagnosed by means of the relevant tests. In most cases, pain in the stomach area (under the end of the sternum, in the upper part of the abdomen, known as the “mouth of the stomach”) predominates, although it may move in some people to the right side, where Localizes the liver.
At other times it is accompanied by nausea and may even vomit the contents of the food ingested before. If they occur repeatedly, they may be accompanied by scraps of blood. As pain is often triggered by ingestion, some patients decrease their meals, eventually leading to weight loss.
Diagnosis of chronic gastritis
To establish the diagnosis of chronic gastritis, gastroscopy is available, showing the characteristic signs of inflammation of the mucosa, such as inflammation of the folds, and redness of the mucosa becoming modular. There are rapid staining methods to identify the presence of H. pylori during gastroscopy.
The diagnosis of chronic gastritis is also histological (it is necessary to obtain a sample by gastroscopy), observing under a microscope the typical changes that occur in the mucosa of the stomach. Differential diagnosis should be made with other diseases such as duodenal ulcer,hiatal hernia, chronic pancreatitis, or irritable bowel syndrome.
Treatment of chronic gastritis
The chronic asymptomatic gastritis does not need to be treated. But in patients with symptoms treatment should be personalized. It is advisable to avoid irritating foods like all heavy, fried and battered foods, carbonated drinks, spices, spices and the tobacco-alcohol combination. Anti- inflammatories are prohibited because of their erosive role on the gastric mucosa, and paracetamol is recommended as an alternative.
In atrophic gastritis produced by H. pylori, it is necessary to establish treatment with antibiotics (the most used pattern is the association of proton pump inhibitors – the best known is omeprazole – amoxicillin, and clarithromycin for 7 or 10 days. The guideline is highly effective, although confirmation of cure should be made over time to establish a new combination of drugs and antibiotics if this is not achieved.
In pernicious anemia, the indefinite supply of vitamin B 12 is required, which is recommended to be administered parenterally, ie by an intramuscular injection usually monthly.
Finally, if anemia occurs due to low iron levels, iron supplements will be used to recover the deposits. This appearance sometimes leads to a worsening of symptoms, as some iron preparations are poorly tolerated causing symptoms similar to gastritis itself. Those that are best tolerated and, if necessary, taken after meals even though their absorption will decrease.
Special types of gastritis
There are some special types of gastritis, among which Menétriè’s disease stands out, of which we will cite some characteristics:
The Menetrier disease characterized folds presenting the stomach wall are markedly thickened inside (this is observed by gastroscopy). In this type of gastritis, there is a decrease in acid secretion and an increase in mucus secretion. It has been considered a premalignant disease because approximately one in ten patients with this disorder develops stomach cancer.
The most frequent symptoms of Menétrièr’s disease are abdominal pain, weight loss, low levels of the protein albumin in the blood, anemia, and edemas. There is an increased risk of ulcers and gastric cancer. The diagnosis is made by endoscopy and biopsy of the gastric mucosa.
Different types of drugs are used to treat this type of gastritis, such as anticholinergics, corticosteroids, and H2 agonists, which reduce protein loss. When the involvement is very important, surgery may be necessary (total removal of the stomach).
In addition to Menétrièr’s disease, there are other special types of gastritis:
- Gastritis by corrosive agents
- Infectious Gastritis
- Eosinophilic Gastritis
- Granulomatous gastritis
- Lymphocytic gastritis
Recommended diet in patients with gastritis
In patients with gastritis it is recommended to follow certain dietary guidelines, avoiding the consumption of foods and drinks that can worsen the symptoms:
Recommended foods for gastritis: pasta, rice, white bread, cooked and skinned vegetables, potato, cooked fruits, lean meats, fish, egg white, skim milk products, water, and caffeine free drinks. Food should be prepared boiled, baked, grilled or grilled, avoiding frying.
Foods to be taken in moderation: raw vegetables, garlic, onion, tomato, cucumber, pepper, whole or fiber products, fruits with skin, whole milk, cream and butter, cured cheeses, cold meats, chocolate, bakery, Grape and citrus, carbonated drinks.
Foods that are best avoided during gastritis: very cold or hot foods and beverages, pepper, vinegar, ground pepper, mustard, coffee, tea, alcohol.
As a general rule, patients with gastritis are advised to ingest small amounts of food, but more often, for example, five times a day. Adequate chewing is recommended and adequate time for each meal, avoiding also lying down immediately after each intake. It is, in short, to give a certain ” digestive rest ” trying to avoid the stimulus of hydrochloric acid that produces the stomach before certain foods.