GASTRITIS

 GASTRITIS

INTRODUCTION:

Gastritis is a histological diagnosis characterized by inflammation of gastric mucosa, although it can be recognized by endoscopy.

I. ACUTE GASTRITIS

Acute gastritis is usually erosive and haemorrhagic.

ETIOLOGY:

Drugs (aspirin, NSAIDs), alcohol, stress due to severe illness, and congestive gastropathy due to portal hypertension.

CLINICAL FEATURES:

 l. Erosive gastritis is usually asymptomatic.

2. It presents with anorexia, nausea, vomiting and abdominal pain. Haematemesis and melena are important manifestations of erosive gastritis.

DIAGNOSIS:

 l. Endoscopy

2. Biopsy

TREATMENT:

1. The consumption of alcohol and drugs (NSAIDs) should be avoided.

2. H2-receptor antagonists (ranitidine 10 mg twice daily, famotidine 20 mg twice daily) started as it improves healing.

3. More potent agent omeprazole or other proton pump inhibitors can be given for more rapid relief.

4. In mild cases, antacids 30 mL 4 - 6 hourly can improve the condition.

5. Advice the patient not to take the drugs on empty stomach.

6. Switch over to selective inhibitors of COX-2, if analgesics are really needed, e.g. valdecoxib or rofecoxib can be prescribed.

II. CHRONIC GASTRITIS

When the acute gastritis remains for the longer time and is not treated, it becomes chronic and is known as chronic gastritis.

ETIOLOGY:

1. Repeated injury to gastric mucosa by tea, coffee, alcohol, spices

2. Infection from throat, teeth, gums and sinuses

3. NSAIDs

4. Autoimmune pathology

5. Very hot beverage

6. Gastrectomy.

There are mainly two types of chronic gastritis:

 A. Type A gastritis

 B. Type B gastritis.

A. Type A Gastritis (less common)

1. It involves body of stomach and spars antrum.

2. It is caused during autoimmune disorders like type I diabetes mellitus, Sjogren’s syndrome, Graves’ disease, Hashimoto disease, myasthenia gravis, etc.

3. It is caused due to autoimmune activity against parietal cells and parietal cell antibodies can be detected in serum.

4. In severe cases, parietal cell atrophy leads to deficiency of intrinsic factor which leads to pernicious anaemia.

5. The disease is asymptomatic and long-term complication is gastric carcinoma.

TREATMENT:

In severe cases, corticosteroids are administered. In mild cases, parenteral iron should be administered.

B. Type B Gastritis

1. This is more common form of gastritis and involves antrum of stomach.

2. The usual cause is gram-negative bacteria H. pylori. The condition is precursor of peptic ulcer.

3. There is possibility of gastric carcinoma.

DIAGNOSIS:

 l. Gastric acid study, i.e. achlorhydria

2. Haemoglobin decreases

3. Serum gastrin increases

TREATMENT:

 l. Anti- H. pylori treatment:

 a. Triple drug therapy: Proton pump inhibitor or ranitidine 400 mg BD, Bismuth subcitrate, Amoxicillin 1 gm or clarithromycin 500 mg or metronidazole 500 mg BD.

 b. Quadruple therapy: Omeprazole 10 mg BD, Tetracycline 500 mg QID, Bismuth subcitrate QID, Metronidazole 500 mg TDS.

 c. Parenteral vitamin B12 is administered.