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Tuesday, August 12, 2025

Gastritis


Definition

Gastritis is an inflammatory condition of the gastric mucosa, which may be acute or chronic, and can be caused by infectious, chemical, or immunological factors. The inflammation may involve the entire stomach or be localised to specific regions (e.g., antrum, corpus).

Classification

1. Acute Gastritis

  • Rapid onset, usually reversible with treatment

  • Causes: infections, alcohol, NSAIDs, stress-related mucosal damage

2. Chronic Gastritis

  • Long-standing inflammation with gradual mucosal atrophy

  • Common causes: Helicobacter pylori infection, autoimmune processes

Etiology

Infectious causes:

  • H. pylori (most common worldwide)

  • Viral (CMV in immunocompromised)

  • Fungal (Candida spp. in severe immunosuppression)

  • Parasitic (rare)

Chemical/irritant causes:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Alcohol

  • Bile reflux

Autoimmune causes:

  • Autoimmune gastritis (associated with pernicious anaemia, vitamin B12 deficiency)

Other causes:

  • Stress-related mucosal disease (burns, sepsis, trauma)

  • Radiation

  • Ingestion of corrosive substances

Pathophysiology

  • Gastric mucosal injury occurs due to disruption of protective mechanisms (mucus, bicarbonate, epithelial integrity)

  • Irritants, infections, or autoimmune activity lead to inflammation, which can progress to mucosal erosion and ulceration

  • In chronic cases, persistent inflammation can cause glandular atrophy, intestinal metaplasia, and increased risk of gastric carcinoma

Clinical Features

Acute Gastritis:

  • Epigastric pain or discomfort

  • Nausea, vomiting

  • Bloating

  • Loss of appetite

  • Haematemesis or “coffee-ground” vomitus in erosive cases

Chronic Gastritis:

  • May be asymptomatic for years

  • Dull epigastric pain

  • Early satiety

  • Nausea

  • In autoimmune gastritis: symptoms of vitamin B12 deficiency (fatigue, glossitis, neurological deficits)

Complications

  • Gastric ulcer

  • Gastrointestinal bleeding

  • Iron deficiency anaemia

  • Pernicious anaemia

  • Gastric adenocarcinoma

  • Gastric MALT lymphoma (with H. pylori)

Diagnosis

History and examination – evaluate for NSAID use, alcohol, previous gastrointestinal disease, systemic illness

Investigations:

  • Endoscopy: visualisation of mucosal inflammation; biopsy for histology and H. pylori testing

  • H. pylori tests: urea breath test, stool antigen test, rapid urease test (CLO), biopsy histology

  • Blood tests: CBC (anaemia), vitamin B12 levels, iron studies, autoimmune antibodies (parietal cell, intrinsic factor) if suspected

  • Fecal occult blood test for bleeding

Management

Treatment is based on cause, severity, and presence of complications.

1. H. pylori-Associated Gastritis

Eradication therapy with triple or quadruple therapy

Triple therapy (14 days):

  • Omeprazole 20 mg orally twice daily (or equivalent PPI)

  • Clarithromycin 500 mg orally twice daily

  • Amoxicillin 1 g orally twice daily (or Metronidazole 500 mg twice daily if penicillin-allergic)

Bismuth quadruple therapy (10–14 days):

  • PPI (e.g., omeprazole 20 mg twice daily)

  • Bismuth subsalicylate 525 mg orally four times daily

  • Tetracycline 500 mg orally four times daily

  • Metronidazole 500 mg orally three times daily

2. NSAID-Induced Gastritis

  • Discontinue NSAID if possible

  • Initiate PPI: e.g., Omeprazole 20–40 mg daily, Lansoprazole 30 mg daily, Pantoprazole 40 mg daily for 4–8 weeks

  • Consider Misoprostol 200 micrograms orally three to four times daily if NSAID continuation is essential and patient is not pregnant

3. Alcohol-Related Gastritis

  • Stop alcohol intake

  • Use PPI or H2-receptor antagonist (e.g., Ranitidine 150 mg twice daily) for symptom relief

  • Antiemetics if needed (e.g., Ondansetron 4–8 mg orally every 8 hours)

4. Autoimmune Gastritis

  • Lifelong vitamin B12 replacement (e.g., Cyanocobalamin 1 mg intramuscularly every 1–3 months)

  • Monitor for gastric carcinoma

5. Stress-Related Gastritis (Critically Ill)

  • Prophylaxis in ICU:

    • PPI (e.g., pantoprazole 40 mg IV daily) or

    • H2-receptor antagonist (e.g., famotidine 20 mg IV every 12 hours)

Supportive and Lifestyle Measures

  • Small, frequent meals

  • Avoid irritants: NSAIDs, alcohol, spicy food, caffeine

  • Smoking cessation

  • Stress management

Prognosis

  • Acute gastritis usually resolves with cause removal and short-term therapy

  • Chronic gastritis requires long-term monitoring for complications, especially with H. pylori or autoimmune forms




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