Gastritis is inflammation of the stomach lining irrespective of the cause. It can be caused by a number of factors, the most common of which are long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with the bacteria Helicobacter pylori. Some people have no symptoms of gastritis (asymptomatic), while others may complain of dyspepsia (indigestion) and a gnawing stomach pain. However, it should be kept in mind that not all patients who complain of such symptoms are suffering from gastritis.
The cells in the stomach lining or mucosa, in addition to secreting acid and enzymes which help in digestion, also produce mucus which helps to protect the lining. Inflammation of the mucosa results in reduced mucus secretion which increases the extent of irritation or erosion of the stomach lining by the stomach acid.
Types of Gastritis
What are the different types of gastritis?
There are broadly two types of gastritis :
- Acute gastritis where the symptoms, which develop suddenly, are often quite severe. It can occur in the backdrop of chronic gastritis where there is a sudden and severe exacerbation or it may not have previously existed by the stomach lining is suddenly inflamed by a known irritant like excess alcohol or drugs.
- Chronic gastritis where the onset is more gradual, with the symptoms developing slowly over time. It is caused by prolonged irritation of the gastric mucosa. Left untreated, complications such as peptic ulcer, gastric bleeding and stomach cancer may develop. Some patients may be asymptomatic, with severe symptoms developing only in case of acute exacerbation.
Another classification, depending upon the changes in the gastric mucosa :
- Erosive gastritis. In this type of gastritis, which may be acute or chronic, the inflammation may be minimal but there is more likelihood of extensive erosion or damage to the gastric lining, leading to bleeding or ulcer formation.
- Non-erosive gastritis. It is a chronic form of gastritis caused mainly due to H. pylori infection. Patients are usually asymptomatic.
Causes of Gastritis
What causes gastritis?
- H. pylori infection (bacteria) is the most common cause of chronic gastritis.
- Medication. Prolonged use of NSAIDs such as aspirin and ibuprofen is the most common cause of erosive gastritis, both acute and chronic. Corticosteroids may also cause gastritis.
- Bile reflux from the small intestine.
- Post-gastrectomy gastritis – develops after partial or subtotal gastrectomy (surgical removal of the stomach).
- Substance abuse like with alcohol and cocaine.
- Trauma – severe injury, including burn injuries.
- Extreme stress – as in severe acute illnesses or major surgeries.
- Autoimmune disorders.
- Pernicious anemia.
- Infection – viral, fungal, parasitic and bacterial (other than H. pylori).
- Ingestion of corrosives.
- Allergy and food poisoning.
Symptoms of Gastritis
What are the signs and symptoms of gastritis?
Patients with gastritis may be asymptomatic or may complain of :
- Frequent indigestion and stomach upset
- Vomiting – this may include fresh blood or dried blood that looks like coffee grounds (hematemesis)
- Burning pain in the upper abdomen which may improve or worsen with meals
- Loss of appetite
- Black tarry stools due to the presence of degraded blood (melena)
How is gastritis diagnosed?
Your doctor may consider one or more of the following investigations to confirm a diagnosis of gastritis.
- Upper gastrointestinal endoscopy – to examine the stomach lining and perform a biopsy if necessary.
- Blood tests – especially for hemoglobin, H.pylori and pernicious anemia.
- Stool test – for occult blood.
Complications of Gastritis
What are the long term effects of gastritis?
If left untreated or in severe acute cases, the following complications may arise :
- Peptic ulcer
- Gastric bleeding with severe blood loss
- Stomach cancer
Treatment of Gastritis
How is gastritis treated?
Treatment will depend upon the underlying cause and may include :
- acid suppression by means of antacids, H2 blockers and proton pump inhibitors (PPI)
- antibiotics in case of H. pylori infection