Gastroenterology

Gastritis: Causes, Classification, Diagnosis and Treatment

  • Clinicals
  • Gastroenterology
  • 2020-08-19 05:00:36
  • 3 minutes, 48 seconds

Gastritis: Causes, Classification, Diagnosis and Treatment

Gastritis refers to inflammation of the gastric mucosa (a layer that lines the stomach).

Normally the inside of the stomach is remarkably resistant to injury from acid and digestive enzymes. In certain situations, the lining of the stomach can become irritated leading to the development of gastritis

Causes

Gastritis is caused by several conditions such as

  • Bacterial infection with Helicobacter pylori,
  • Drugs (NSAIDs) lead to chronic erosive gastritis
  • Alcohol intake,
  • Stress leads to acute stress gastritis, and
  • Autoimmune phenomena.
  • Eosinophilic gastritis may occur from an allergic reaction to roundworm infestation.

Many cases are asymptomatic, but dyspepsia and GI bleeding sometimes occur.

Predisposing factors

  • Alcohol
  • Highly seasoned food
  • Infected food
  • Eating too much or too rapidly
  • Radiation therapy
  • Uremia

Classification

Gastritis is classified based on various factors such as the severity of mucosal injury into two:

  1. Erosive or
  2. Nonerosive

It is also classified according to the site of involvement to three types

  • cardia,
  • body and
  • antrum.

It can be further classified histologically based on the inflammatory cell type as acute or chronic.

Some forms of gastritis involve acid peptic and H. pylori disease. Additionally, the term is often loosely applied to nonspecific (and often undiagnosed) abdominal discomfort and gastroenteritis.

Pathophysiology of gastritis

During the irritation of the mucous membrane as a result of infection or corrosive substances

The mucous membrane become

  • edematous
  • Hyperemic
  • Superficial erosion

Acute gastritis

Acute gastritis is characterized by PMN infiltration of the mucosa of the antrum and body. Chronic gastritis implies some degree of atrophy (with loss of function of the mucosa) or metaplasia.

It predominantly involves the antrum (with subsequent loss of G cells and decreased gastrin secretion) or the corpus (with loss of oxyntic glands, leading to reduced acid, pepsin, and intrinsic factor).

Erosive Gastritis

Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defenses. It is typically acute, manifesting with bleeding, but maybe subacute or chronic with few or no symptoms.

The diagnosis is by endoscopy.

Treatment is supportive, with the removal of the inciting cause.

Certain ICU patients (eg, ventilator-bound, head trauma, burn, multisystem trauma) benefit from prophylaxis with acid suppressants.

Causes

Causes of erosive gastritis include NSAIDs, alcohol, stress, and less commonly radiation, viral infection (eg, cytomegalovirus), vascular injury, and direct trauma (eg, nasogastric tubes).

Superficial erosions and punctate mucosal lesions occur.

These may develop as soon as 12 h after the initial insult.
Deep erosions, ulcers, and sometimes perforation may occur in severe or untreated cases.
Lesions typically occur in the body, but the antrum may also be involved.

Acute stress gastritis

This is a form of erosive gastritis, occurs in about 5% of critically ill patients. The incidence increases with the duration of ICU stay and length of time the patient is not receiving enteral feeding.

Pathogenesis likely involves hypoperfusion of the GI mucosa, resulting in impaired mucosal defenses.

Patients with head injury or burns may also have increased secretion of acid.

Symptoms and Signs

Patients with mild erosive gastritis are often asymptomatic, although some complaint of dyspepsia, nausea, or vomiting. Often, the first sign is hematemesis, melena, or blood in the nasogastric aspirate, usually within 2 to 5 days of the inciting event.

Bleeding is usually mild to moderate, although it can be massive if deep ulceration is present, particularly in acute stress gastritis.

Diagnosis

Acute and chronic erosive gastritis are diagnosed endoscopically.

Treatment

For acute gastritis;
Nil by mouth until the symptoms subside
Bland diet offered
Intravenous fluids

If bleeding is present either through vomiting (hematemesis)or melena stool.

For bleeding:

Endoscopic hemostasis

For acid suppression:

A proton pump inhibitor or H2 blocker is indicated.
In severe cases, bleeding is managed with IV fluids and blood transfusion as needed.

Endoscopic hemostasis should be attempted, with surgery (total gastrectomy) a fallback procedure.

Angiography is unlikely to stop severe gastric bleeding because of the many collateral vessels supplying the stomach.
Acid suppression should be started if the patient is not already receiving it.

For milder cases, removing the offending agent and using drugs to reduce gastric acidity may be all that is required.

Prevention

Prophylaxis with acid-suppressive drugs can reduce the incidence of acute stress gastritis. However, it mainly benefits certain high-risk ICU patients, including those with severe burns, CNS trauma, coagulopathy, sepsis, shock, multiple trauma, mechanical ventilation for > 48 h, hepatic or renal failure, multiorgan dysfunction, and history of peptic ulcer or GI bleeding.

Prophylaxis consists of IV H2 blockers, proton pump inhibitors, or oral antacids to raise intragastric pH > 4.0. Repeated pH measurement and titration of therapy are not required.

Early enteral feeding also can decrease the incidence of bleeding.


References:
author

Daniel Ogera

Medical educator, passionate about simplifying difficult medical concepts for easier understanding and mastery by nursing and medical students.

Article details

About this article:
  • Topic:Clinicals
  • Duration:3 minutes, 48 seconds
  • Subtopic:Gastroenterology

Trending Posts

Medcrine Shop

Do You Have Questions ?

We'll help you to grow your career and growth.
Contact Us Today