What is Gastritis?
Gastritis is inflammation of the stomach wall. This usually starts in the inner lining of the stomach known as the gastric mucosa and eventually penetrates deeper into the underlying layers. Most cases of gastritis are due to infection with the H.pylori (Helicobacter pylori) bacteria or the long term and excessive use of anti-inflammatory drugs. Other factors such as stress and spicy foods may exacerbate the symptoms but do not cause gastritis on its own. Gastritis typically presents with a gnawing pain in the upper abdomen.
Gastritis is one of the most common stomach disorders. The stomach is a hollow sac with a multi-layered wall that contains hydrochloric acid and digestive enzymes produced by the stomach lining. It has an additional barrier of mucus that protects the lining from making contact with the corrosive acid and enzymes. However, when this mucus barrier is disrupted, the stomach lining (gastric mucosa) is exposed to the acid and enzymes and becomes injured. Eventually this can spread to large areas of the stomach and if left untreated the inflammation will lead to open sores known as stomach ulcers.
Gastritis can be acute and chronic. Acute gastritis develops suddenly and the symptoms are intense. It may be just an acute episode in chronic gastritis or occur without any previous history of gastritis. Acute gastritis is more likely to lead to ulcers (erosive gastritis) or lead to bleeding from the stomach wall (haemorrhage). Chronic gastritis on the other hand develops gradually and persists for long periods, even years. It is typically non-erosive but may become erosive during acute attacks.
Causes of Gastritis
There is a number of causes of gastritis but by far the most common include H.pylori (bacteria) infection and NSAIDs (non-steroidal anti-inflammatory drugs). Other causes may include excessive alcohol consumption, viral infections, autoimmune diseases, radiation exposure, ingestion of toxic/corrosive substances, physiological stress and stomach surgery.
H.pylori (Helicobacter pylori) is a specific type of bacteria that is suited to survive in the stomach acid. It propels itself towards the inner stomach lining (gastric mucosa) and attaches to it where it compromises the stomach mucus barrier. At the same time it may increase gastric acid secretion. NSAIDs are commonly used drugs for treating pain and inflammation. It blocks pathways that allow the stomach to protect itself with the formation of the mucus barrier and also increases gastric acid secretion. While short term use of NSAIDs may cause some irritation, gastritis is associated with long term and excessive use of these drugs.
The other causes mentioned above account for a minority of cases compared to H.pylori infection and NSAIDs. Nevertheless it is worth considering as possible causes in patients who are unresponsive to standard treatment and no clear etiology can be defined. One cause that is sometimes confused is that of physiological stress. This is when the body is under severe stress like in a burn victim or after major surgery. In this case gastritis develops and is known as stress gastritis. It must not be confused with mental/emotional stress (psychological) which can make the gastritis worse but does not usually cause it.
Signs and Symptoms
The signs and symptoms may vary to some extent. It is not uncommon for patients with chronic gastritis to have no symptoms (asymptomatic). Gastritis symptoms may include :
- Stomach pain
- Indigestion (upset stomach)
- Belching (burping)
- Vomiting, sometimes even blood
- Loss of appetite
- Abdominal bloating
- Black tarry stools due to degraded blood
The typical gastritis symptom is a gnawing stomach pain. For some this may be nothing more than a dull ache whereas for others it can be episodes of severe pain. The discomfort or pain is usually isolated to the left uppr abdominal quadrant, which includes just under the bottom of the left ribcage. However, the location of the pain may not be so specific. When gastritis is associated with other conditions like acid reflux (heartburn) and duodenal ulcers, the pain may extend up into the chest or to the right and lower down the abdomen. Gastritis pain may be eased or worsened by eating meals and this is also dependent on the type of food consumed. Spicy foods, caffeinated drinks and alcoholic beverages are more likely to make the pain worse.
Diagnosis of Gastritis
Usually the symptoms reported are sufficient for a diagnosis of gastritis but this may require further investigation, particularly in chronic cases. An upper gastrointestinal endoscopy will allow the doctor to inspect the stomach lining and even take a sample for further testing (biopsy). Blood tests will be able to detect H.pylori infection and stool tests can detect the presence of blood which may be an indication of bleeding in the stomach.
Treatment of Gastritis
Gastritis treatment requires multiple approaches. This includes the use of drugs such as :
- H2-receptor blockers
- Proton pump inhibitors (PPIs)
The drugs above are used for acid suppression to treat gastritis of any cause. With H.pylori infection, certain antibiotics are needed and this is known as eradication therapy. It may have to be repeated several times to totally eliminate the bacteria from to stomach.