Gastritis: Understanding Types, Diagnosis and Treatment Options

What is Gastritis

Gastritis is the inflammation of the mucosal liningof the stomach. The inflammation may be contained within one region or be patchy in many areas. The inflammation is usually limited to the mucosa, but some forms involve the deeper layers of the gastric wall. The inflammation can be due to either erosion or atrophy. Erosive causes include stresses such as physical illness and medication such as NSAIDs (Nonsteroidal Anti-inflammatory drugs). Atrophic causes include a history of prior surgery (gastrectomy), pernicious anemia, alcohol use and helicobacter pylori infection.

Causes of Gastritis

Acute Gastric

• Ingestion of irritating foods such as excessive amounts of tea, coffee, pepper etc.
• Ingestion of highly seasoned foods
• Ingestion of food infected with microbes such as Staphylococcus, Salmonella, E. coli etc.
• Alcohol abuse
• Use of NSAIDs, aspirin, corticosteroids
• Ingestion of corrosive agents – acids and alkaline which may cause the mucosa to become gangrenous or to perforate.
• Chemotherapy or radiation therapy to the upper abdomen
• Bile reflux
• Severe stress that is related to critical illness
• Cigarette smoking

Chronic Gastric

• Autoimmune diseases such as pernicious anaemia
• Excessive ingestion of caffeine, coffee, and tea
• NSAIDs
• Alcoholism
• Smoking
• Bile reflux
• H. pylori infection
• Benign or malignant ulcers of the stomach

Types of Gastritis

Acute Gastritis

It has a sudden onset. It is associated with severe signs and symptoms. It has a short duration (lasts several hours to some few days). It is characterized by superficial lesions or superficial erosion of the gastric mucosa. The gastric erosions are limited to the mucosa, which will be edematous and have sites of bleeding. Erosions can be diffuse throughout the stomach or localized to the antrum.

Chronic Gastritis

It has a gradual onset. It is characterized by deeper lesions. It has a long duration. It results from repeated exposure to irritating agents or recurring episodes of acute gastritis. There are three types of chronic gastritis.They are superficial gastritis, atrophic gastritis, and gastric atrophy.

Superficial GastritisThis is the onset of chronic gastritis. Lesions are not so deep. Irritation affects stomach lining but does not affect gastric glands and chief cells. It leads to red, edematous surface epithelium, small erosions, and decreased mucus content.

Atrophic Gastritis: There is wasting away of gastric tissue. Inflammation extends much deeper. It destroys some gastric glands, parietal cells and chief cells.

Gastric Atrophy: This is the final stage of chronic gastritis. There is complete wasting of gastric tissue or total loss of glandular structure. It may be a precursor of gastric cancer.

Pathophysiology of Gastritis

Gastritis occurs when there is a breakdown of the normal gastric mucosal barrier. This mucosal barrier normally protects the stomach tissue from auto-digestion by HCL and pepsin. When the barrier is broken, HCL is able to diffuse back into the mucosa. The back diffusion of acid results in tissue edema, disruption of the capillary walls with loss of plasma into the gastric lumen, and possible hemorrhage. Hence, in gastritis, the gastric mucous membrane becomes edematous and hyperemic (congested with fluid and blood). The gastric mucous membrane also undergoes erosion or ulceration, which is usually superficial. The ulceration can lead to hemorrhage. The damaged gastric mucosa may also lead to a decreased secretion of gastric juice.

Diagnostic Investigations & Test

• Physical examination for signs and symptoms
• Gastric secretion analysis for achlorhydia, hypochlorhydia, or hyperchlorhydia
• Endoscopy / Esophagogastroduodenoscopy
• Upper GI radiographic studies
• Full blood count for Hb, WBC count
• Breath, urine, or serum test for H. pylori.
• Histologic examination of a tissue specimen obtained by biopsy / Gastric biopsy to confirm diagnosis and rule out gastric cancer

Gastritis Treatment

Acute gastritis is a self-limiting, if infection occurs the immune system clears it off. Chronic gastritis always requires combinations of treatment therapy to manage and cure the disease. Management focuses on relieving symptoms and addressing the underlying causes. Treatment options may include:

Proton pump inhibitors (PPIs):PPIs block the protein needed for the production of gastric acid. Example of PPIs include, omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), dexlansoprazole (Dexilant), and rabeprazole (Aciphex).

Antacids:Antacid neutralizes stomach acid to ease ingestions and heartburn. Examples of antacids includes Tums, Mylanta, Rolaids and Maalox

Histamine 2 blockers (H2):H2 blockers reduce the level of acid the stomach produces. They include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and Ranitidine.

Antibiotics:If H. pylori infection is present, combinations of selected drugs are recommended for effective management. They include a proton pump inhibitor, antibiotics and sometimes bismuth salts.

Blood transfusion may be transfused in anemic patients.

Lifestyle modifications:Avoiding irritants such as alcohol, NSAIDs, and spicy foods, along with stress management techniques can help manage gastritis.

Nursing Management of Gastritis

The following are the measures to put in place in the care of patient's with Gastritis

• Reassure patient and family.
• Assess patient’s pain.
• Assess patient for signs of dehydration.
• Monitor and record vital signs.
• Monitor intake and output.
• Observe for the desired and side effects of drugs administered.
• Observe for vomiting, hematemesis and melaena.
• For acute gastritis, start patient on nil per os to support healing of the mucosa and slowly advance to liquids and to a normal diet.
• Ensure patient avoids foods that can cause pain or discomfort.
• Ensure patient reduces the intake of dietary fat.
• Ensure patient eats smaller and more frequent meals.
• Encourage stress management techniques.
• Reinforce the importance of completing prescribed drugs, especially H. pylori treatment to prevent relapse.
• Educate patient to avoid smoking and alcoholism.
• Encourage bed rest.
• Educate patient to avoid NSAIDs and aspirin unless prescribed. If prescribed, reinforce the need to take these drugs with food.
• Ensure personal hygiene.
• Avoid oral fluids and foods when patient is vomiting.
• Administer prescribed intravenous fluids. This is usually prescribed when the patient is on nil per ooze.