Gastritis is categorized as acute or chronic. Sudden, severe inflammation of the stomach lining is called acute gastritis. Inflammation that lasts for a long time is called chronic gastritis.
Erosive gastritis is a type of gastritis that is usually not associated with significant inflammation but can lead to sloughing off of the stomach lining. Erosive gastritis can cause bleeding, erosions, or ulcers. Erosive gastritis may also be acute or chronic.
Helicobacter pylori (H. pylori) infection is the most common cause of chronic nonerosive gastritis. H. pylori are bacteria that infect the stomach lining. H. pylori are usually acquired from other humans. In areas with poor sanitation, H. pylori may be transmitted through contaminated food or water. H. pylori infection is more commonly encountered in areas with poor sanitation and higher population density where the rates of infection are noticeably higher.
The most common cause of erosive gastritis—acute and chronic—is prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Other agents that can cause erosive gastritis include alcohol, cocaine, and radiation.
Traumatic injuries, critical illness, severe burns, and major surgery can also cause acute erosive gastritis. This type of gastritis is called stress gastritis.
Less common causes of erosive and nonerosive gastritis include
• autoimmune disorders in which the immune system attacks healthy cells in the stomach lining
• some digestive diseases and disorders, such as Crohn’s disease and pernicious anemia
• viruses, parasites, fungi, and bacteria other than H. pylori
Symptoms of gastritis, also called dyspepsia, include:
• upper abdominal discomfort or pain
• blood in vomit
• black, tarry stools
• red blood in the stool
The most widely used and effective diagnostic test for gastritis is endoscopy with a biopsy of the stomach. The endoscope allows direct visualization and examination of the lining of the esophagus, stomach, and first portion of the small intestine. If necessary, a biopsy is performed, and it involves collecting tiny samples of tissue for examination with a microscope, and to look for H. pylori in these tissues.
Other tests used to identify the cause of gastritis or any complications include the following:
• Upper gastrointestinal (GI) series. The patient swallows barium, a liquid contrast material that makes the digestive tract visible in an x ray. X-ray images may show changes in the stomach lining, such as erosions or ulcers.
• Blood test. The doctor may check for anemia, a condition in which the blood’s iron-rich substance, hemoglobin, is diminished. Anemia may be a sign of chronic bleeding in the stomach.
• Stool test. This test checks for the presence of blood in the stool, another sign of bleeding in the stomach.
• Tests for H. pylori infection. The doctor may test a patient’s breath, blood, or stool for signs of infection. H. pylori infection can also be confirmed with biopsies taken from the stomach during endoscopy.
Treatment of gastritis is based upon:
1- Lifestyle changes: avoiding foods or beverages that induce or worsen gastritis is necessary; common items to avoid include spices, carbonated beverages, caffeine (including chocolate), alcohol, smoking, tomato cause, peppermint, and garlic.
2- Medications that reduce the amount of acid in the stomach in order to alleviate symptoms that may accompany gastritis and promote healing of the stomach lining. These medications include
• Antacids: these medications are based upon different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in the stomach. These drugs may produce side effects such as diarrhea or constipation.
• proton pump inhibitors (PPIs), such as omeprazole, rabeprazole, esomeprazole and others. PPIs decrease acid production more effectively than H2 blockers.
Depending on the underlying cause of the gastritis, additional measures or therapies may be required. For example, if gastritis is caused by prolonged use of NSAIDs, discontinuing NSAIDs, reducing the dose or switching to another class of medications for pain, and the addition of a PPI may be recommended.
Treating H. pylori infections is important, even if a person is not experiencing symptoms from the infection. The most common treatment regimen is a triple therapy that combines a PPI and two antibiotics—usually amoxicillin and clarithromycin—to kill the bacteria.