What should you know about gastritis?

In this post I’m going to talk about a very common pathology: gastritis.

The term gastritis refers to the inflammation of the mucosa of the stomach (the mucosa is the layer of cells that covers the stomach inside. This mucosa fulfills a protective function and gastritis inflames it and even in some cases it causes atrophy of it, being able to cause more serious damages. Gastritis can be acute or chronic, depending on its duration.

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Causes of Gastritis:

There are many factors that can cause gastritis: bad eating habits, stress, excessive consumption of anti-inflammatory drugs, alcohol, tobacco, infections, some autoimmune pathologies, etc., but let's talk about the most important ones.

1) Food
Predispose to the appearance of gastritis very spicy foods, with vinegar, citrus, coffee. Also if we eat only one or two meals a day we are also exposed to gastritis (there is a greater secretion of acid).

2) Stress
The stress and anxiety that we accumulate (whatever the cause) causes disorders in our nervous system (alteration of acetylcholine, histamine and gastrin) that are capable of producing an increase in the acid secretion of the stomach.

3) Medications
Some drugs of common use if they are used continuously can be harmful to the stomach mucosa. The classic example are anti-inflammatory drugs (aspirin, ibuprofen, ketoprofen, naproxen, etc.). There are also gastritis secondary to chemotherapeutic agents and radiotherapy.

4) Alcohol and tobacco
Ethanol is transformed into acetaldehyde and this has numerous negative effects on our body, including the stomach. The same applies for nicotine. Also the use of cocaine causes gastritis.

5) Infections
Numerous infections (bacteria, viruses, fungi, parasites) can cause gastritis. The most common is caused by the bacterium Helicobacter pylori, which invades and inflames the gastric mucosa. H. pylori infection can be found in 20% of individuals younger than 40 years and in 50% of individuals older than 60 years. Although its mechanism of transmission is not completely clear, it is believed to be from person to person through the fecal-oral route or through the ingestion of contaminated water or food.

6) Special forms of gastritis
Related to Crohn's disease, celiac disease, eosinophilic due to food allergies, etc.

Symptoms

Sometimes there are no symptoms but usually the patient complains of burning or pain in the epigastrium (upper and middle abdomen), heartburn, abdominal distension, belching, nausea and sometimes vomiting. Symptoms of gastroesophageal reflux, loss of appetite may occur.

The burning in the stomach usually worsens with meals (there is greater production of gastric acid for digestion) but usually improves with dairy.

Hematemesis may occur (vomiting with blood, which, being partially digested, may have a slightly dark color or be similar to coffee grounds) when gastritis is associated with ulcers that bleed. In these cases, melena is also present (dark stools such as tar, with a very bad smell) from the blood that has already been completely digested. This clinical picture requires immediate medical assistance.

Diagnosis

The precise diagnosis is obtained through endoscopy of the upper gastrointestinal tract (gastroscopy) with a biopsy of the mucosa, whose result confirms the diagnosis. The biopsy is also used to carry out the determination of Helicobacter pylori (although there are also tests for H. pylori in samples of blood, feces and breath).

The mucosa during an endoscopy looks red (as with reddish spots).

Laboratory tests may show anemia (if the gastritis is hemorrhagic or there is an ulcer).

Treatment for gastritis

1) Pharmacological treatment
It will depend of the cause. Usually antacids are used in all cases (neutralize gastric acids), histamine type 2 receptor blockers (important for gastric secretion) such as cimetidine, ranitidine, famotidine and proton pump inhibitors (decrease the secretion of acid) as omeprazole, pantoprazole, esomeprazole, lansoprazole). These drugs help maintain a not so acid pH in the stomach, so irritation decreases and healing is facilitated.

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As for gastritis of infectious origin, Helicobacter pylori is the most frequent microorganism and its treatment is based on a combination therapy, since it is not easy to eradicate. The triple therapy of amoxicillin + clarithromycin + proton pump inhibitor is usually used, since the cure with this combination exceeds 85%.

2) Lifestyle changes
People under intense stress should try to calm their daily life, practicing relaxation techniques, exercise, yoga, sleeping properly and generally doing quiet activities.

Regarding food, we will mention allowed, limited and prohibited foods.

- Allowed or recommended foods: bread, pasta, rice, cereals, cooked and skinless vegetables (avoid flatulent vegetables such as broccoli, cauliflower, cabbage), lean meats, low-fat dairy products, white cheeses, non-citrus fruits (also not very acidic), egg whites, water, non-citrus juices. The preparation of the food must be grilled or baked , avoiding frying.

-Foods to be consumed in moderate amount: raw vegetables, fruits with skin, whole milk, cream, butter, mayonnaise, yellow cheeses, eggs, sausages, olive or vegetable oil, chocolate, cakes, sodas.

-Forbidden foods: pepper, vinegar, mustard, very spicy foods, very elaborate stews, coffee, tea, alcohol, flatulent vegetables, juices of citric or acid fruits.

It is advisable to eat small portions of food, but more often (about 5 times a day), avoiding fullness. In addition, the meal schedule must be respected.

Medications that irritate the mucosa of the stomach should be stopped.

Prognosis and Complications

Almost all acute gastritis improve rapidly at the start of treatment but the prognosis will depend on what is causing it.
A gastritis may be complicated by hemorrhage (if it progresses to an ulcer) and with an increased risk of gastric cancer.

If the symptoms do not improve, you should go to the doctor.

References:

1. https://emedicine.medscape.com/article/175909-overview
2. https://emedicine.medscape.com/article/176156-overview#showall