Understanding Gastritis: Symptoms, Causes, Pathophysiology and Nursing Care

What is Gastritis

Gastritis is the inflammation, erosion or irritation of the gastric mucosa, which is the protective lining of the stomach. Gastritis can manifest as either acute or chronic, depending on the duration and severity of the symptoms. The gastric mucosa serves as a protective barrier that prevents the stomach's acidic environment from damaging the underlying tissues. When the integrity of the gastric mucosa is compromise, it increases susceptible to irritation by hydrochloric acid (HCL) and digestive enzymes and results in inflammation.

Risk factors of Gastritis

Several factors can increase the risk of developing gastritis, including:

• Age: Older adults are at increased risk of developing gastritis due to the natural decline in gastric mucosal defenses.
• Medications: Long-term use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Aspirin, and certain other medications can irritate the stomach lining.
• Alcohol Consumption: Excessive alcohol consumption can lead to inflammation of the stomach lining.
• Autoimmune Disorders: Autoimmune conditions (such as Type 1 diabetes and Hashimoto's disease) that cause the immune system to attack the stomach lining can lead to chronic gastritis. Vitamin B-12 deficiency is also associated with autoimmune gastritis

Causes of Gastritis

Gastritis occurs when the gastric mucosae lining is inflamed by gastric juice and the stomach acid. The stomach itself produces acid which aid in digestion and kill harmful microorganisms present in the stomach. The acid can erode the lining of the stomach, due to such corrosion, the stomach cells produce its natural protective barrier that lines the stomach and some part of the duodenum. Alteration in this normal balance allow acid to damage the lining causing gastritis.

The causes can be categorized into infectious and non-infectious factors:

Infectious:H. pylori is the most common cause of chronic inflammation of the stomach lining. Other infections, includes viral and bacterial infections associated with stomach flu can cause short term – self-limiting infections.

Non-infectious:Other causes include excessive alcohol consumption, prolonged use of NSAIDs (such as aspirin and ibuprofen), autoimmune diseases (Type 1 diabetes, Hashimoto's disease), and physical stress.

Other causes include:

• Inflammatory conditions such as Sarcoidosis, Crohn's disease, celiac disease
• Chemotherapy
• Radiation treatments
• Acid or bile reflux
• Vomiting repeatedly
• Overuse of recreational drugs such as tobacco, or cocaine

Pathophysiology of Gastritis

The gastric mucosa produces a specialized cell that produce mucus to coat the stomach lining, a protective barrier that prevents the stomach's acidic environment (HCL and digestive enzymes) from damaging the underlying tissues. When the protective barrier altered, the stomach lining gets exposed to corrosion by irritation agent (HCL and pepsin), resulting in inflammation. As a result, the mucosa becomes hyperemic, edematous and formed pus leading to superficial erosion. This trigger the release of histamine and vagus nerve stimulation, exacerbating the erosion which further leads to superficial ulceration and hemorrhage.
In chronic gastritis, persistent inflammation causes atrophy of the gastric tissue, which result in the reduction parietal cells. Decrease in parietal cells results in loss of intrinsic factor, which is essential for vitamin B12 absorption. Depletion in Vitamin 12 results in pernicious anemia.

Signs & Symptoms of Gastritis

Symptoms of gastritis can vary but commonly include:

• Abdominal pain or discomfort
• Nausea and vomiting
• Loss of appetite
• Bloating and belching
• A feeling of fullness in your upper abdomen after eating
• Gnawing or burning ache (Indigestion)
• In severe cases, symptoms may also include gastrointestinal bleeding, which can manifest as black or bloody stool

Diagnostic Investigations & Test

• Physical examination
• Upper GI endoscopy.
• History taking
• Upper GI series – x-ray of the digestive tract after a barium solution swallow to distinguish areas of concern.
• Urea breath test to test for H. Pylori
• Stool sample may rule out an H. Pylori or blood in stool
• Blood test to check for anemia or H. Pylori infection

Treatment

• Histamine (H2) – receptor antagoniststo control HCL and minimize inflammation
• Proton pump inhibitors
• Antibiotics for H. pylori
• Antacidsto neutralize gastric acid and control heartburns
• Vasopressin to prevent bleeding
• Vitamin B12 to prevent pernicious anaemia
• Analgesics such as Paracetamol for headache
• Antiemetics such as Phenergan to control vomiting

Nursing Management of Gastritis

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

• Monitor and record vital signs
• Monitor Fluid and Electrolyte Balance
• Conduct and obtain laboratory investigations
• Encourage rest periods between activities throughout the day.
• Teach patient to avoid gastric irritants (such as NSAIDs, coffee, alcohol, and tobacco)
• Educate the patient about dietary changes such as avoiding spicy and acidic foods
• Educate patient on high fiber intake
• Encourage the patient to take balanced diet
• Teach patient relaxation techniques
• Teach the patient on ways of reducing stress levels using techniques such as meditation
• Provide emotional support and positive reinforcement
• Administer medications as prescribed.

Preventive measures

• Regular handwashing to prevent H. pylori infection.
• Limiting alcohol intake can help protect the stomach lining.
• Avoid overuse of NSAIDs and other irritant, if possible under medical supervision.
• Eating a balanced diet and avoiding foods that irritate the stomach can help maintain gastric health
• Monitoring and managing underlying health conditions can help prevent gastritis
• Manage stress
• Quitting smoking

Differential Diagnosis

• Peptic ulcers
• Pancreatitis
• Gastric lymphoma
• Gastric cancer
• Cholecystitis
• Functional dyspepsia
• Celiac disease