Gastritis refers to an inflammation in the lining of the stomach. It can be caused by a number of factors, but this condition is always the result of an imbalance in the gastric juices created by the gastric mucosa.
The term “gastritis” is commonly used by doctors and the public alike to explain the brief episodes of transient upper abdominal pain, nausea and vomiting which frequently affect much of the population. Gastritis, however, is usually not the cause of these upsets and, in its strictest sense, gastritis is a diagnosis made by a pathologist when evidence of inflammation and damage to the stomach lining is seen in a biopsy specimen taken at endoscopy. True gastritis may be of acute onset in which case symptoms are usually sudden and more severe; otherwise, it may be a chronic, often silent problem, that develops more slowly.
Gastritis can have many symptoms, and may even go unnoticed to a person who has this condition. A person may have pain in the center of the stomach, quite often towards the upper portion of the abdomen. Other symptoms may include:
- nausea and vomiting
- bloating and gas
- weight loss and/or loss of appetite
Vomiting from gastritis may contain blood. Any time this symptom occurs it is important that qualified medical help is sought immediately.
Acute gastritis may produce no symptoms but can be associated with short-lived dyspepsia, lack of appetite, nausea or vomiting. It can occasionally be severe enough to cause gastrointestinal bleeding. The most common cause is ingestion of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). It can also occur during the early stages of infection with the bacteria Helicobacter pylori. Most cases resolve by themselves, but endoscopy and biopsy may be required to exclude other conditions such as peptic ulcer disease or cancer.
At endoscopy, the mucosa may appear swollen, reddened and inflamed. There may be small, shallow breaks in the surface lining or even tiny areas of bleeding. These changes are usually confined to the stomach rather than the first part of the small intestine, referred to as the duodenum. Other tests, such as blood tests, X-rays and scans are usually not necessary for diagnosis unless an alternative condition is suspected during investigation. Often, no specific therapy is required, but short courses of antacids, acid-suppressing drugs or drugs for nausea may be necessary. If possible, aspirin or NSAIDs (nonsteroidal anti-inflammatory drugs) should be immediately stopped.
Over use of aspirin, ibuprofen, and other over-the-counter pain medications, as well as possible heavy alcohol use, can cause the mucosa to erode away. This is a condition referred to as erosive gastritis.
Chronic gastritis is extremely common and usually results from infection with Helicobacter pylori (HP). In the USA and other developed countries, infection with HP becomes more common with increasing age. Approximately 40-50% of people are infected by the age of fifty. In underdeveloped countries, the infection rate can be much higher —in some areas up to 90% of the population can be infected by adulthood.
In the vast majority of cases, stomach biopsies show mild chronic gastritis but usually this produces no symptoms and the patient is unaware of the infection. A small percentage, however, will develop peptic ulcers because of the infection. Currently, there is little evidence that patients with symptoms of indigestion but no abnormality at endoscopy will benefit from treatment of the infection.
Much less commonly, chronic gastritis may occur when the body's own immune system attacks the acid-secreting cells of the stomach lining. This is a form of auto-immune disease and the reasons why it occurs are unknown. It mostly affects middle-aged or elderly women, and usually causes no symptoms. The inflammation of the gastric lining continues over many years until the stomach's ability to secrete acid is lost.
Also lost is the ability to secrete intrinsic factor, which is necessary for binding and absorption of the important vitamin, B12. Deficiency of vitamin B12 eventually leads to a decrease in red blood cells, a condition called pernicious anemia. This problem is often discovered at this stage when the patient presents with tiredness, anemia, or (rarely) symptoms in the limbs such as numbness or tingling. The diagnosis is confirmed by blood tests which show evidence of anemia, a low level of vitamin B12 and characteristic abnormalities in the shape of the red blood cells when examined under a microscope. Further investigations are usually undertaken by a specialist and treatment consists of replacement of vitamin B12 by regular injections. Nothing can be done to restore acid secretion but there is little evidence that this impairs the body's ability to digest and absorb food. There may be a small increase in the risk of stomach cancer in patients suffering from long-standing pernicious anemia.
There can be many causes of chronic gastritis:
- an autoimmune disorder
- Crohn's disease, which may be caused by genetic factors and or immune disorders
- some surgical procedures may increase the chances of developing gastritis
- liver or kidney failure
- Helicobacter pylori
Chronic, untreated gastritis can result in metaplasia, a condition in which the erosion of the stomach lining is not correctly replaced with normal tissue. This is a result of severe damage to the stomach lining.
Gastritis is diagnosed by a biopsy of the stomach. This is performed by having an endoscopic examination known as an EGD. Additional blood tests and tests for Helicobacter pylori may be required.
Reducing the amount of acid in the stomach is one method of controlling gastritis. Mild episodes of gastritis are usually treated with over-the-counter antacids. These medications neutralize the acid in the stomach
More severe symptoms may require a form of medication known as proton-pump inhibitors. These medications' main purpose is a long-lasting reduction in the amount of acid created by the stomach.
Antibiotics may be used to eliminate Helicobacter pylori from the stomach.