Gastritis is one of the most common digestive conditions for which the patient presents himself to the doctor. It signifies inflammation of the stomach mucosa and can have multiple causes: infectious, drug, inflammatory, autoimmune, toxic, stress.
Gastritis can be classified into acute gastritis with sudden onset, and chronic, with long-lasting development. Gastritis is similar to gastritis, which signifies a damage to mucosal cells by contact with irritating chemical agents (anti-inflammatory, biliary juice, alcohol, etc.); the difference of these entities is based on anamnesis and histopathological examination of the biopsy taken from the stomach. Most forms of gastritis or gastropathy are mild and treat with lifestyle and diet changes as well as with drugs that lower the acidity of the gastric juice.
Gastric acid juice has two main functions: digestion and elimination of germs that we ingest. The lining of the stomach is lined with a mucus layer to protect against gastric acid. When the balance between protective mucus and gastric acid is disturbed, there is inflammation of the first exposed gastric tissue, the mucosa.
- Infectious: The most common cause of chronic gastritis is Helicobacter pylori infection (about 50% of the population), an acid-resistant bacterium that is transmitted orally and can be complicated by ulcer and gastric cancer; in immunodepressed patients (HIV, neoplasms, diabetics, etc.) gastritis and viruses such as Citomegalovirus, Herpes simplex, fungi such as Candida, parasites such as Stongiloides Stercotralis, etc. may occur.
- Anti-inflammatory drugs: frequent use of non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, naproxen, etc.) or aspirin may damage the stomach lining and produce gastropathy or ulcer.
- Biliary reflux: Excess bile in the stomach can irritate the mucosa.
- Excessive use of concentrated alcohol: has irritating and erosive effect on the mucosa; is a common cause of acute gastritis.
- Stress: After major surgery, burns or severe infections, the so-called “stress gastritis” that occurs by lowering stomach blood flow can result in acute inflammation of the stomach lining.
- Autoimmune: autoimmune gastritis – in which autoantibodies are formed against gastric mucosal cells; is associated with vitamin B12 deficiency anemia and possibly other autoimmune diseases (Hashimoto’s thyroiditis, type I diabetes)
- Inflammatory: eosinophilic gastritis – caused by the accumulation of eosinophilic cells in the gastric mucosa; was Crohn – inflammatory bowel disease in which, in addition to predominantly intestinal and colon affection, there may be gastric damage.
The symptom of the patient with gastritis consists of upper abdominal pain, nausea, vomiting, feeling of early satiety, bloating. Some patients are asymptomatic.
The suspicion of a diagnosis of gastritis arises from the anamnesis, that is, the discussion with the patient, and the physical examination. Certain diagnosis of gastritis is the result of an imagistic assessment of the patient by superior digestive endoscopy, a high specific method, or baritased transit, a method less and less used. Gastrointestinal suspicion is not indicative of upper gastrointestinal endoscopy, except for the following: over 40 years of age, family history of digestive and non-digestive cancer, persistent abdominal pain despite treatment, frequent use of anti-inflammatory drugs, anemia, involuntary weight loss, vomiting persistent. These situations may indicate the occurrence of gastritis complications such as gastric ulcer or gastric cancer.
Superior digestive endoscopy is a minimally invasive diagnostic method and consists of introducing a flexible tube with a top chamber through the mouth through the food path. It visualizes the esophagus, the stomach and the duodenum. Inflammation in gastritis can include the whole stomach (pangastrititis) or only a certain segment (antral or corporeal gastritis). By endoscopy, biopsy can be drawn from equivocal lesions, and a rapid urease test for Helicobacter pylori can also be performed.
A useful method in the diagnosis of gastritis without performing superior digestive endoscopy is testing for Helicobacter pylori infection, the most common cause of this disease. Testing can be done non-invasively through the blood (Ac antiHelicobacter pylori), faeces (fecal antigen) and respiratory test.
The treatment of gastritis depends on the triggering cause:
- Antibiotic therapy against Helicobacter pylori infection
- Medicines that inhibit acid production in the stomach: proton pump inhibitors (omeprazole, esomeprazole, pantoprazole, etc.) and histamine receptor inhibitors (ranitidine, famotidine, cimetidine); these preparations reduce acidity and allow the healing of the gastric mucosa.
- Antacids: temporarily neutralizes gastric acidity and rapidly relieves symptoms.
- Avoiding the consumption of concentrated alcohol
- Avoiding the use of anti-inflammatory drugs or the combination of drugs that inhibit acidity
- Beneficial changes to the lifestyle and diet recommended in gastritis are: small and frequent meals, avoiding spicy spices, toasts and fats, avoiding alcohol, carbonated beverages, concentrated sweets and acidic foods.