Acute Gastritis

Gastritis helicobacter - intermed mag[1]

Acute gastritis is an inflammation of the stomach lining, which may develop due to the use of certain drugs or other underlying causes that result in abdominal pain and discomfort.

Presentation

The most common symptoms of gastritis are pain or upper abdominal discomfort [9]. Some patients, especially elderly people, may present no symptoms at all until they start to suffer from bleeding [10]. The pain caused by gastritis is usually described as soreness or burning located in the upper central part of the abdomen; however, it might be felt in the left upper part of the abdomen or in the back. Abdominal discomfort may also be present in patients with gastritis. Other symptoms that may develop in patients with acute gastritis include belching, fullness, bloating, nausea and vomiting. Depending on the severity of the inflammation, the vomit may be clear, yellow or green, and may contain blood. The severity of the symptoms does not always correlate to the actual physical changes in the stomach lining. Some patients may suffer from severe symptoms even though the lining of the stomach shows only minor changes. Others may not experience any symptoms, while endoscopy shows evidence of gastritis.

Workup

Complete history about the symptoms and risk factors of developing gastritis is important in reaching the diagnosis. Several tests can be ordered to verify the diagnosis including routine complete blood count to check for general health; fecal test to look for blood in stool [11]; and checking for the presence of Helicobacter pylori bacteria by testing saliva, blood, or breath. Upper endoscopy of the esophagus and the stomach may be conducted to examine the lining of the stomach [12]. A biopsy may be taken and examined to rule out other causes [13]. Imaging studies with X-rays may be required to exclude structural problems.

Treatment

Patients who take aspirin or other nonsteroidal anti-inflammatory drugs regularly are found to have a higher risk of developing dyspepsia and gastritis, which necessitates the discontinuation of these drugs in order to reduce the associated gastrointestinal conditions [14] [15]. Treatment of gastritis caused by Helicobacter pylori bacterial infection includes three drugs, levofloxacin, amoxicillin, and a proton pump inhibitor (PPI). In some patients this combination may not be effective as a treatment, in these cases the former two drugs are replaced with bismuth and tetracycline along with metronidazole and the PPI [14]. It is thought that Helicobacter pylroi treatment may deteriorate gastroesophageal reflux disease (GERD); however, there is no evidence of that. It is recommended to use the PPI pantoprazole in patients who also take clopidogrel, as it appears to cause only minimal interaction regarding antiplatelet activity. Patients suffering from vomiting require the administration of fluids and electrolytes. Medical treatment is usually sufficient in managing gastritis. Although, in the case of stomach gangrene (phlegmonous gastritis), surgical intervention may be required to remove the affected area of the stomach.

Prognosis

Gastritis responds well to treatment and has good prognosis; however, symptoms may flare up in some patients depending on the factors affecting the lining of the stomach [1]. Some patients may suffer from internal bleeding or severe symptoms, which requires further workup in order to rule out more serious conditions.

Etiology

The lining of the stomach may be damaged or weak, which allows irritation by digestive acids. This results in acute gastritis. The causes listed by the National Institutes of Health for the developing of this condition include bacterial infections (especially Helicobacter pylori) [2], exaggerated alcohol consumption, and medications such as corticosteriods and nonsteroidal anti-inflammatory drugs (NSAIDs) [3]. Other risk factors include extreme stress, bile reflux, cocaine use, poison ingestion, kidney failure, surgery, Crohn disease and other digestive diseases, viral infections, and autoimmune disorders resulting in the attack of the stomach lining by the immune system.

Epidemiology

There are not sufficient statistical data about gastritis. 10% to 20% of patients taking nonsteroidal anti-inflammatory drugs are reported to suffer from dyspeptic symptoms; however, the prevalence may range from 5% to 50% [4]. Up to 25% of the United State's population are reported to suffer from dyspeptic symptoms. 50% of patients who undergo upper endoscopy are diagnosed with gastritis or other non-ulcer dyspepsia [5]. Several factors may affect the development of acute gastritis due to a bacterial infection with Helicobacter pylori in developing countries. These comprise environmental factors, geography, age, socio-economic status, and strain virulence [6]. Acute gastritis due to autoimmune diseases is more prevalent among people from Scandinavian ancestry or North Europeans.

Sex distribution
Age distribution

Pathophysiology

Gastric mucosal blood flow is decreased due to nonsteroidal anti-inflammatory drugs and alcohol consumption resulting in the loss of the mucosal protective barrier. Sulfhydryl compounds in gastric mucosa are depleted by alcohol consumption, whereas prostaglandin production is inhibited by NSAIDs [7]. A severe inflammatory response with increased mucosal permeability and degradation of gastric mucin is induced by Helicobacter pylori bacterial infection. The gastric epithelium is affected by its cytotoxicity [2]. Bacteria do not grow normally in the stomach because of the low gastric fluid pH. However, ingested bacteria may become more invasive in the case of damaged gastric mucosa due to ingestion of foreign bodies, ulcer, or carcinoma [8]. An autoimmune chronic inflammation may be stimulated by anti-parietal cell antibodies, resulting in lymphocytic infiltrate and leading to parietal and chief cells loss.

Prevention

Prevention of gastritis is achieved by avoiding the underlying cause, like excessive alcohol consumption, toxins ingestion, or the use of NSAIDs [16]. Gastritis due to bacterial infections can be evaded by maintaining a good hygiene, hand washing, and ensuring the food and water are clean.

Summary

Acute gastritis is an inflammatory process in the gastrointestinal system. It may affect the whole stomach or part of it and can be divided into two main categories: erosive and nonerosive gastritis [1]. The most common cause of gastritis is the use of nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen; however, there are different etiologic factors including excessive alcohol consumption, autoimmune diseases, and bacterial infection with Helicobacter pylori. Most patients with gastritis appear to be asymptomatic [2]. When symptoms develop they include burning upper abdominal pain and discomfort. Patients may also suffer from nausea and vomiting. Laboratory studies include blood and fecal tests to check the general status of health and to look for blood in the stool. Upper gastroesophageal endoscopy and biopsy sample may be done in order to rule out other conditions. Many patients do not suffer from any symptoms and are diagnosed incidentally when they undergo endoscopy for other reasons. Other breath tests may be performed to confirm the presence of Helicobacter pylori bacteria.

Gastritis is easily managed and the treatment depends on the causing factor. In case of nonsteroidal anti-inflammatory drugs (NSAIDs), it is advised to discontinue these drugs as they irritate the stomach. Alcoholic patients are encouraged to stop drinking. Patients who are diagnosed with Helicobacter pylori infection will need drug treatment, which initially includes three drugs; a proton pump inhibitor, levofloxacin, and amoxillin. If there is no improvement, the latter two drugs are replaced with bismuth and tetracylin and metronidazole is added to the treatment. Surgical intervention is usually not necessary, except in cases of stomach gangrene. Gastritis scarcely leads to complications and patients usually respond to treatment with good prognosis; however, in rare cases, severe symptoms or bleeding may occur. Avoiding the overuse of NSAIDs and alcohol consumption will decrease the risk of developing gastritis. Maintaining a good hygiene will also help in the prevention of gastritis due to bacterial infections.

Patient Information

Acute gastritis is an inflammation of the stomach resulting in abdominal pain and discomfort, which is caused by different underlying factors.

Causes

Several causes are associated to the developing of acute gastritis including certain drugs such as aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs; excessive alcohol consumption; toxins ingestion; severe stress; direct trauma; bacterial infections (especially Helicobacter pylori bacteria); viral and fungal infection.

Presentation

Patients suffering from gastritis usually present with burning pain in the upper abdomen, which may also be felt in the back. Eating may exacerbate the pain or relieve it. Other symptoms include nausea and vomiting. Most patients have a history of nonsteroidal anti-inflammatory drug use or the exposure to toxin chemicals. Many patients do not present symptoms at all. They are usually diagnosed by accident while undergoing an endoscopy for other purposes. Elderly people have a higher likelihood of developing painless gastritis. The severity of the symptoms does not necessarily correspond to the actual changes seen in the stomach by endoscopy. While patients suffering from severe symptoms may have minor changes; others may present no symptoms at all, even though endoscopy reveals gastritis.

Diagnosis

The doctor will take a thorough history to check for risk factors. Blood and stool tests will be ordered to help in the diagnosis of the inflammation. Endoscopy and biopsy samples may be required in some patients to rule out other underlying causes. In some cases, the doctor will also order X-rays to check structural problems in the gastrointestinal system.

Management

Treatment of gastritis depends on the causing agent. In case of nonsteroidal anti-inflammatory drug use, it is encouraged to stop the drug and an antacid may be prescribed to reduce symptoms. Alcohol consumption should be avoided. Gastritis due to bacterial infection will require treatment with a combination of drugs, which appears to be effective in the eradication of the bacteria. In very rare cases, surgical intervention may be needed to remove severely affected areas of the stomach.

Outcome

Gastritis has very good outcomes with rare complications; however, some patients may suffer from severe symptoms or bleeding.

Prevention

Avoiding the risk factors and preventing the underlying causes, such as excessive alcohol consumption and the use of nonsteroidal anti-inflammatory drugs will decrease the risk of developing gastritis. Washing hands regularly, making sure that food and drinks are clean, and keeping a good hygiene will prevent bacterial infections.

Self-assessment

References

  1. Chey WD, Wong BC. Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007; 102: 1808-1825.
  2. Glickman JN, Antonioli DA. Gastritis. Gastrointest Endosc Clin N Am. 2001; 11: 717-740.
  3. Lanza FL. A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol. 1998; 93: 2037-2046.
  4. Larkai EN, Smith JL, Lidsky MD, et al. Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 1987; 82: 1153-1158.
  5. El-Serag HB, Talley NJ. Systemic review: the prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther. 2004; 19:643-654.
  6. Hunt RH, Xiao SD, Megraud F, et al. World Gastroenterology Organization. Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline. J Gastrointestin Liver Dis. 2011; 20: 299-304.
  7. MacMath TL. Alcohol and gastrointestinal bleeding. Emerg Med Clin North Am. 1990; 8: 859-872.
  8. Turner MA, Beachley MC, Stanley D. Phlegmonous gastritis. AJR Am J Roentgenol. 1979; 133: 527-528.
  9. Talley NJ, Vakil N. Practice Parameters Committee of the American College of Gastroenterology: guidelines for the management of dyspepsia. Am J Gastroenterol. 2005; 100: 2324-2337.
  10. Talley NJ. American Gastroenterological Association. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 2005; 129: 1753-1755.
  11. Cutler AF, Havstad S, Ma CK, et al. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology. 1995; 109: 136-141.
  12. Hirota WK, Zuckerman MJ, Adler DG, et al. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc. 2006; 63: 570-580.
  13. Kim N, Kim JJ, Choe YH, et al. Diagnosis and treatment guidelines for Helicobacter pylori infection in Korea [in Korean]. Korean J Gastroenterol. 2009; 54: 269-278.
  14. Drepper MD, Spahr L, Frossard JL. Clopidogrel and proton pump inhibitors--where do we stand in 2012?. World J Gastroenterol. May 14, 2012; 18(18): 2161-71.
  15. Laine L, Curtis SP, Cryer B, et al. Risk factors for NSAID-associated upper GI clinical events in a long-term prospective study of 34 701 arthritis patients. Aliment Pharmacol Ther. November 2010; 32(10): 1240-8.
  16. Lanza FL, Chan FK, Quigley EM, et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009; 104: 728-738.

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