What Is Gastritis and What are its Causes, Symptoms and Treatment

Gastritis is the inflammation of the inner lining of the stomach.

  • Stomach infections, and injury caused by the action of digestive acids, enzymes and drugs on the lining of the stomach, or auto-immune disorders, may be the cause of inflammation.
  • Gastritis may be either asymptomatic or there may be pain and discomfort in the abdominal area and occasionally nausea and vomiting too.
  • Typical symptoms of gastritis help doctors to diagnose the condition, but sometimes an endoscopic examination may be required to confirm the diagnosis.
  • Antacids, which neutralize the action of stomach acids, are used as the first line of treatment.

Normally, the lining of the stomach is equipped with the capacity to withstand the action of strong digestive acids, but if the lining of the stomach gets irritated, inflammation results, precipitating gastritis.

Causes Of Gastritis

Injury to the lining of the stomach resulting from infections, or from the regular use of drugs such as aspirin, may be the cause of gastritis. Auto immune diseases that attack the stomach lining may also cause this condition.

 Helicobacter pylori bacteria, which colonize the stomach, may be a major contributor to gastritis. Other bacterial, viral or fungal infections can also cause gastritis. People with an immune system that is impaired due to AIDS or by the use of immunosuppressant drugs, as well as those who have cancer or prolonged illnesses are particularly prone to gastritis.

Along with inflammation, if the stomach lining is wearing away too, such a condition is called erosive gastritis. Regular intake of aspirin and frequent use of NSAIDs or nonsteroidal anti-inflammatory drugs such as ibuprofen may irritate the lining of the stomach, resulting in erosive gastritis. Ingestion of chemicals which are corrosive in nature and infections due to viruses and bacteria as well as Crohn’s disease are known to cause erosive gastritis. Generally, this condition develops gradually and often affects people who are healthy in all other aspects.

A sudden injury, or a severe illness, elsewhere in the body, can cause a type of erosive gastritis called acute stress gastritis; the reason for which is unknown. It is assumed that the stress to the body caused by severe burns, or heavy blood loss, may be impairing the ability of the lining of the stomach to renew and repair itself, because of the reduced blood flow to the stomach due to its more urgent demand elsewhere.

Damage caused to the lining of the stomach, due to radiation which is delivered to the mid-area of the torso, for investigative or treatment purposes can result in radiation gastritis.

After a gastrectomy surgery to remove a part of the stomach, inflammation often develops in the area around the sutures, leading to a condition called postgastrectomy gastritis. It is assumed that postgastrectomy gastritis is caused either due to the stomach lining being exposed to large amounts of bile produced by the liver, or due to the temporary disruption in the blood flow to the lining, caused by the surgery.

When there is thinning of the inner lining of the stomach, with the consequent loss of digestive acid and enzyme producing cells in the lining, such a condition is called atrophic gastritis. It may occur in people who have undergone partial gastrectomy and in those who have chronic Helicobacter pylori infection. A condition called autoimmune gastritis results, when the lining of the stomach is attacked by the antibodies produced by the body itself.

Sometimes, white blood cells called eosinophils crowd on the walls of the stomach as an immune response to an irritant, usually a round worm infestation, resulting in eosinophilic gastritis.

When another kind of white blood cells called lymphocytes crowd in the stomach walls, it results in lymphocytic gastritis. A malabsorptive disorder called celiac sprue is known to be caused by the accumulation of lymphocytes in the upper part of the small intestine.

 Ménétrier’s disease is a peculiar kind of gastritis in which the wall of the stomach becomes riddled with thick folds, enlarged digestive glands and cysts with fluid accumulation in them. The cause is assumed to be a chronic infection by Helicobacter pylori bacteria or an auto immune response.

Symptoms and Complications

Gastritis may be asymptomatic or symptoms such as discomfort and pain in the upper abdomen or a feeling of nausea and vomiting, may be present, which are generally attributed to indigestion. If a peptic ulcer develops due to gastritis, symptoms are more severe.

Ménétrier’s disease and erosive gastritis often cause nausea and occasional vomiting. These symptoms can also develop due to lymphocytic gastritis and radiation gastritis too. Acute stress gastritis causes a very mild form of dyspepsia or indigestion. Radiation gastritis, atrophic gastritis, erosive gastritis and postgastrectomy gastritis can cause severe dyspepsia, due to the reduced production of digestive enzymes by the damaged lining of the stomach.

Radiation gastritis and erosive gastritis often lead to the formation of ulcers which may start bleeding, resulting in hematemesis or vomiting of blood or melena (having stools of black color due to the blood content in them). Ulcers are most common in acute stress gastritis and they typically start bleeding in the first few days following a critical injury or severe illness. On the other hand, ulcers due to erosive gastritis or radiation gastritis cause bleeding gradually, over a period of time.

Prolonged bleeding due to the ulcers caused by gastritis can precipitate anemia, and its typical symptoms such as weakness, dizziness and fatigue. If an ulcer perforates the wall of the stomach, the contents from inside the stomach may enter the abdominal cavity, setting off peritonitis, which is the inflammation of peritoneum that lines the abdominal cavity. A suddenly worsening abdominal pain may be an indication, of the inflammation of peritoneum or the possible development of infections.

Gastritis can cause the narrowing of the outlet from the stomach, which can result in frequent vomiting accompanied by a persistent feeling of nausea. This is typical of eosinophilic gastritis, and occasionally, it may be caused by radiation gastritis too.

In Ménétrier’s disease, edema may result from fluid retention due to the inflammation of the stomach lining. The risk of developing stomach cancer is high in people with Ménétrier’s disease, with about 10% of people with this condition developing it within a few years. People who have atrophic gastritis are prone to developing metaplasia, a condition in which precancerous cells develop in the lining of the stomach; it has the potential to cause stomach cancer in some people. Severe fatigue due to anemia, is found in people with atrophic gastritis as well as postgastrectomy gastritis, because, absorption of Vitamin B12   becomes impaired due o the absence of the intrinsic factor which binds to B12, facilitating its absorption and use in RBC production.

Diagnosis

Gastritis is suspected when people complain of nausea, pain and discomfort in the upper part of the abdomen. Without further tests, treatment with antacids is started, but if the symptoms persist, endoscopic examination is conducted to get a better picture of the interiors of the stomach. A biopsy of the tissue taken from the lining of the stomach may also be done, if required.

Treatment Of Gastritis

The first line of treatment focuses on relieving the symptoms rather than curing the cause. When the symptoms are mild, antacids to neutralize the stomach acid are prescribed. The drugs which contribute to gastritis are discontinued or substituted by safer ones. But antacids need to be taken frequently, and they have side effects too; they cause either diarrhea or constipation. Drugs such as proton pump inhibitors and histamine-2 (H2) blockers are found to be more convenient and effective than antacids, but the former is reserved for severe cases of gastritis. Antibiotics are given too, if there is some infection along with the inflammation. Sucralfate, which reduces irritation, is often prescribed along with the other drugs. Surgical correction of the wall of the stomach may be necessary, if an ulcer has perforated it.

NSAIDs which irritate gastric lining should be avoided by those who have erosive gastritis, and COX-2 inhibitors such as celecoxib may be taken instead, when necessary. They should be used sparingly though, as long-term use of coxibs is a risk factor for stroke as well as heart attack. Often, proton pump inhibitors or misoprostol are given as they afford some protection to the lining of the stomach.

 Acute stress gastritis may eventually resolve by itself, once the injury that has caused it, is brought under control. But, people who are still critically ill, several days after the injury, have a high risk of dying from bleeding caused by acute stress gastritis. To avoid this dangerous situation, drugs which decrease the production of acid and prevent ulcers from developing, are routinely given to post operative patients and those in the intensive care unit following severe injuries. Several other attempts at overcoming the risk of death due to bleeding ulcers, such as blood transfusion or cauterization of the ulcers while performing an endoscopy, have not been successful. Surgical removal of the stomach may be the only available option, to save the life of the patient, if bleeding persists.

When anemia is caused by malabsorption of vitamin B12 due to atrophic gastritis, lifelong injections of   B12   are the only remedy, as this condition is incurable.  Postgastrectomy gastritis also does not have any cure, the same as atrophic gastritis.

If eosinophilic gastritis causes blockage of the outlet from the stomach, treatment with corticosteroids is tried, but if it is not successful, surgical correction may be necessary. In the absence of any effective treatment with drugs, surgical removal of all or part of the stomach is the remedy for Ménétrier’s disease.

Gastritis Video Summary

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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One Response to What Is Gastritis and What are its Causes, Symptoms and Treatment

  1. Dan Ortiz says:

    Gastritis can be caused by infection, irritation, autoimmune disorders (where the body’ s immune system mistakenly attacks the stomach), or backflow of bile into the stomach (bile reflux). Gastritis can also be caused by a blood disorder called pernicious anemia.”:`-

    My own, personal web portal
    http://www.healthmedicine101.comzw

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