Gastritis

Gastritis is the irritation or inflammation of the inner lining of the stomach (mucosa). In healthy people, the stomach produces acid, various enzymes, and mucus. During gastritis, the amount of mucus is reduced, and the stomach gets exposed to its own acid, which causes pain and burning in the stomach region along with regurgitation of food and occasional vomiting. Gastritis can be managed and treated with dietary changes and therapeutic agents with a very high success rate.

Everyone usually experiences this condition at least once in their lifetime, owing to a wide range of causes. Infections, medications, smoking, alcohol abuse, stress and immune system-related conditions are mainly responsible for gastritis. It can be either acute or chronic. If symptoms are very prominent, severe and resolve in a few days, it is termed as acute gastritis. In contrast, chronic gastritis has mild to moderate symptoms that linger for many years.

Gastritis is of four types, namely:

• Acute gastritis
  It causes the most prominent symptoms. It is usually erosive or haemorrhagic (associated with bleeding) and is caused by the use of non-steroidal anti-inflammatory (NSAIDs) drugs, such as diclofenac, aceclofenac, aspirin, and ibuprofen; alcohol (binge drinking); and chemotherapy drugs. The symptoms of acute gastritis include pain in the upper part of the stomach, nausea or vomiting, loss of appetite, and sometimes vomiting of blood or passing black-coloured stools (melaena). (Read more - Blood in stool causes and treatment)
• Chronic gastritis
  It occurs when either the stomach gets inflamed repeatedly, or if inflammation extends over a period of six months. Helicobacter pylori infection is mainly the cause of chronic gastritis. Sometimes, the prolonged use of painkillers or alcohol can also lead to chronic gastritis. The symptoms of chronic gastritis include epigastric discomfort, heartburn, regurgitation of food, bloating, nausea, and indigestion. 
• Autoimmune gastritis
  It is one of the rare forms of gastritis. It occurs when the body’s defence cells produce antibodies against the cells of the stomach, which leads to excessive mucus and acid production. It tends to be a chronic issue that is persistent for many years and is diagnosed by an endoscopic biopsy. Autoimmune gastritis can increase the risk of stomach cancer. The symptoms of autoimmune gastritis are similar to those of chronic gastritis.
• Erosive gastritis
  It is a rare variant of gastritis. It results from ulcerations and erosion of the stomach mucosa and causes bleeding from the ulcers. The symptoms of erosive gastritis include severe pain in the stomach along with bloody vomit (hematemesis) and melaena.

Acute gastritis or erosive gastritis do not occur in stages, as they are usually severe and short lived. Chronic gastritis is staged based on the endoscopic and biopsy findings (histopathology findings) obtained from the person.

The symptoms show a wide diversity based on the type of gastritis. A burning sensation in the stomach and in the central part of the chest (heartburns) is a common symptom of gastritis. Many people may not have any symptoms and may experience some form of indigestion only.

The symptoms of gastritis include:

• Burning sensation in the stomach or upper part of the abdomen.
• Heartburn (Burning in the chest region).
• Excessive burping.
• Regurgitation of food into the food pipe (oesophagus) or in the mouth.
• Bloated feeling in the abdomen.
• Feeling of fullness or heaviness after meals.
• Nausea.
• Vomiting.
• Indigestion.
• Loss of appetite.
• Hiccups.

The severity of the symptoms may vary depending upon the cause and the type of gastritis. Nevertheless, there are some alarming, red-line symptoms; it is advisable to consult your doctor if you show any of the following signs and symptoms:

• Severe pain in the upper abdomen or the stomach region (stabbing or gripping pain).
• Vomiting of blood (hematemesis).
• Passing dark or black stools.
• Dizziness or faintness.
• Shortness of breath.
• Weakness.
• Paleness.

These symptoms may indicate a severe form of gastritis or erosive gastritis, which needs prompt treatment.

Causes

Gastritis has a wide range of causes, making it a common condition. These causes vary from a simple infection to the overuse of drugs. Both acute and chronic gastritis have different causative agents.

• Causes of acute gastritis
  ​The common causes of acute gastritis are:
  • Use of aspirin and other painkillers (NSAIDs).
  • Alcohol.
  • Bacterial infection by H. pylori. (Read more - Stomach infection causes and treatment)
  • Radiation.
  • Viral infection by cytomegalovirus.
• Causes of chronic gastritis
  The causes of chronic gastritis include:
  • Infections, the most common being the H. pylori.
  • Alcohol and smoking.
  • Autoimmune diseases.
  • Crohn’s disease.
  • Sarcoidosis.
  • Regular intake of painkillers.

H. pylori infection and use of NSAIDs are the two most common causes, which can lead to both acute as well as chronic gastritis. If the infection remains untreated, it can result in the formation and recurrence of ulcers, which can increase the chances of developing stomach cancer.

Risk factors

Anyone can acquire acute gastritis, while chronic gastritis has some predisposing or risk factors. Some of the factors are listed below:

• Old age
  The stomach’s capacity to produce protective mucus reduces with age, which predisposes a person to get affected by the acid produced by the stomach.
• Alcohol consumption
  Alcohol tends to irritate or erode the stomach’s lining, making it prone to the acid and other digestive enzymes.
• Use of painkillers
  Prolonged and regular use of painkillers decreases the protective mucus production in the stomach, thereby exposing it to the stomach acid, which further leads to the damage of the inner lining.
• Smoking
  Similar to alcohol, smoking increases the stomach’s acid secretion, which leads to gastritis.
• Infections
  Repeated infections due to bacteria, virus, or parasites can increase the chances of developing gastritis.
• Stress
  Severe physical and physiological stress caused by trauma, burns injury, or severe infection can damage the stomach linings.
• Other diseases
  Other diseases, such as HIV/AIDS, sarcoidosis, or Crohn’s disease, can cause gastritis.
• Autoimmune conditions
  Certain autoimmune conditions predispose a person to develop gastritis. These conditions include Hashimoto’s diseases, pernicious anaemia, and type 1 diabetes.

In a majority of the cases, the symptoms are sufficient to diagnose gastritis, whether acute or chronic. A physical examination along with certain tests, including endoscopic biopsy, confirms the diagnosis.

• Physical examination
  A proper medical history along with a thorough examination of the abdomen can help in diagnosis. In case of erosive gastritis, the skin becomes pale due to blood loss.
• Blood test
  Certain blood investigations can help diagnose gastritis. These include:
• Complete blood count
  It can show low haemoglobin levels and an increased white blood cells count.
• Vitamin B12 levels
  They can be low due to pernicious anaemia.
• Routine stool test
  It can show the presence of blood or blood components in the stool which indicates bleeding from the stomach.
• Endoscopy
  A small tube (scope) is passed through the food pipe (oesophagus) into the stomach, which helps in visualising the inner lining of the stomach. A piece of tissue from the area that shows redness or erosion is collected and evaluated under a microscope (biopsy).
• Test for H. pylori
  It is detected by a stool test or breath test. In the commonly performed breath test, the person is asked to drink a liquid containing carbon. The H. pylori bacteria break down this liquid in the stomach. Thereafter, the person is asked to blow into a bag, which is then sealed. An infected person will show the presence of radioactive carbon in the airbag.

Occasionally, when chronic gastritis leads to ulceration, a barium meal test (an X-ray taken after giving a liquid to drink) is performed to confirm the diagnosis of ulceration. However, an endoscopic evaluation and biopsy are the conclusive tests for finalising the diagnosis of gastritis.

Certain variants of gastritis, such as autoimmune diseases or infective gastritis, are difficult to prevent, while other forms of gastritis can be prevented with certain lifestyle modifications. These modifications include:

• Avoid use of painkillers, such as aspirin or NSAIDs. Ask your doctor for safer alternatives.
• Limit alcohol intake.
• Quit smoking.
• Eat small and frequent meals to reduce excessive acid production.
• Avoid excessively spicy food.
• Restrict the intake of caffeine.

Fortunately, most forms of gastritis have an effective cure and treatment. When the cause of gastritis is determined, a specific therapy usually clears the disease. The treatment of gastritis is symptomatic (use of antacids, proton-pump inhibitors, or H2 blockers), and definitive therapy includes the use of antibiotics or anti-parasitic drugs.

• Antacids
  This class of drugs includes magnesium and aluminium salts, which neutralise stomach acid and reduce pain and burning. However, they can cause diarrhoea or constipation.
• Proton Pump Inhibitors
  This class of drugs reduces the acid production of the stomach, thereby relieving the symptoms and healing the irritation or inflammation. Some inhibitors are pantoprazole, omeprazole, rabeprazole, and esomeprazole.
• H2 Blockers
  This class of drugs reduces the acid production of the stomach but is relatively less potent than proton pump inhibitors. Ranitidine, nizatidine, and famotidine are some examples.
• Antibiotics
  They are used to kill or stop the growth of bacteria, which infect and damage stomach linings, particularly H. pylori. They include amoxicillin, metronidazole, or clarithromycin.

In a majority of the cases, combination therapy along with lifestyle modification helps manage gastritis.

Lifestyle management

Gastritis has an impact on the normal lifestyle. Particularly, the chronic form needs extensive modifications to avoid complications, as medications are not sufficient. Lifestyle modifications for gastritis include:

• Meal plans
  Consuming small and frequent meals works well, as a large meal results in the formation of more acid, and the stomach capacity also plays an important role (could result in regurgitation). In addition, a long gap between meals can also result in acid production, which further damages the stomach linings.
• Use of probiotics
  Probiotics are known to replenish the normal gut flora and help in healing gastric ulcers, however, they do not affect acid secretions of the stomach. Curd and buttermilk are the natural probiotics and should be included in the diet.
• Avoiding alcohol
  Alcohol is known to irritate the linings of the stomach.
• Avoiding smoking
  Smoking is also one of the known factors that increases acid secretions in the stomach.
• Avoiding spicy foods
  Spicy or other irritating foods are known to increase the acid secretion of the stomach and damage its inner lining.
• Pain management
  Alternative or other safer pain-relieving measures or medications help in reducing acid secretion in the stomach.
• Weight management
  Losing weight or achieving target BMI helps in reducing the severity of chronic gastritis. Besides, a diet rich in fruits, vegetables, and whole grain can be beneficial.
• Stress management
  Stress is another factor that can increase acid secretions of the stomach. Managing your stress with yoga, breathing techniques, and meditation can be helpful.

Prognosis

Gastritis is easily treatable and has a very good cure rate. An improvement is observed as the treatment starts. Acute gastritis invariably resolves quickly, while chronic gastritis requires a treatment for a longer duration. However, very few cases when left untreated or poorly treated result in complications.

Complications

Chronic gastritis mostly and unfortunately on poor or no treatment leads to complications as mentioned below:

• Bleeding
  Acute erosive gastritis or even chronic gastritis if untreated can erode the inner lining of the stomach, which like our skin, results in bleeding upon erosion. This bleeding can be in the form of a bloody vomit (hematemesis) or passing of black tarry stools (melaena).
• Anaemia
  If bleeding from the inner lining of the stomach continues for a longer duration (over 3-6 months), it can result in a decrease in the haemoglobin levels.
• Ulcers
  If untreated, gastritis leads to an ulcer formation. Ulceration results in the worsening of symptoms; rarely, if the ulcer perforates, it spills over the stomach contents into the abdominal cavity. This causes infection and inflammation of the abdominal cavity (peritonitis), leading to hospitalisation with a need for urgent surgical intervention.
• Narrowing of the passage
  It is one of the rarest complications and is very slow to develop. Usually, radiation-related gastritis results in the narrowing of the stomach outlets.
• Stomach cancer
  It is a rare complication and may take years to develop.