Medicine for Africa - Medical Information Service

ASTRITIS

Definition:
 
Gastritis is an inflammation of the innermost mucosal layer of the stomach which contains the glands which excrete hydrochloric acid and the enzyme pepsin, both of which initiate the digestive process. Gastritis can be an acute inflammation, usually appearing shortly after a heavy or fatty meal, or after the ingestion of stomach irritants such as alcohol, caffeine, nicotine or food allergens (e.g. shellfish). It can also be a chronic process that develops slowly over time, caused by several different mechanisms such as bacterial and viral infections, or by the development of antibodies against glands (see below), and can be accompanied by a variety of symptoms. Chronic Gastritis is medically divided into three different types:

type A, type B and type C.

In addition to those, there exist combinations of these three as well as other less common types. Chronic gastritis, if untreated, can cause ulcers of the gastric mucosa and/or the duodenum, which is the first part of the small intestine, that leads out of the stomach.

 
Symptoms:
 
Acute gastritis usually appears within an hour after a meal that 'did not sit well in your stomach', and can cause feelings of bloating, heartburn and slight nausea, sometimes with vomiting.

Chronic gastritis has generally no characteristic symptoms unless an ulcer develops which can cause a severe bloating sensation, bleeding, fever and a progressively increasing feeling of being ill. The ulcer may over time lead to anemia (loss of red blood cells) due to slow bleeding from the site of the destroyed stomach lining tissue (=ulcer) with an associated loss of iron in the blood. Iron deficiency then leads to general weakness, loss of energy, decreased oxygen transport in the blood with subsequent less than efficient functioning of various organs (kidney, liver, heart, digestive tract, brain etc.) and more. If the degeneration of the stomach lining tissue (mucosa) leads to loss of glands, or if certain antibodies against one's own gastric glands develop, a vitamin B12 deficiency can occur accompanied by symptoms of poor digestion. If not discovered and treated in time, this can lead to a decrease in muscle mass, i.e. shrinking of muscle tissue (muscle wasting), and nerve damage with development of tingling sensations (paresthesias) over certain body areas or extremities.

If the ulcer destroys the entire mucosa, it causes a perforation of the stomach tissue, with subsequent massive blood loss and possible death if not treated immediately by surgical intervention.

 
Diagnosis:
 
When evaluating symptoms of gastritis, it is often difficult to separate gastritis-like symptoms generated by psychologically caused stress situations, or symptoms secondarily to other disease processes, from primary symptoms of gastritis.

Acute gastritis can usually be diagnosed by its symptoms. However, if the symptoms do not disappear after a few days or appear frequently, further evaluation by a physician is indicated in order to rule out another disease process which may be hidden behind those symptoms, and to assure that the acute gastritis does not become a chronic process.

Chronic gastritis can be diagnosed by ultrasonography, CT-scan, tests of stomach acidity levels, certain blood or breath tests, or by gastroscopy (gastroduodenoscopy). Gastroduodenoscopy, certainly one of the most specific tests, is performed by inserting a flexible tube through the mouth down the esophagus into the stomach and the first part of the small intestine in order to evaluate the lining of the stomach. At this time, small biopsies are taken from areas of inflammation which are then diagnosed by a pathologist who can determine the kind of inflammation according to the kind of cell changes present. Chronic gastritis is divided into three major groups:
 
Gastritis type A: is usually present in people of advanced age, or, sometimes in younger people, as it can also be caused by immunological factors. This type can lead to a loss of glands in the gastric mucosa as well as to a loss of absorbing factors ('intrinsic factor') due to development of specific antibodies with subsequent vitamin B12 deficiency (see above).
 
Gastritis type B: is usually caused by bacteria and occasionally by a virus. Today, the bacterium 'Helicobacter pylori' is one of the most predominant and most prevalent causes of this type of gastritis. It is not yet clearly established how these bacteria are transmitted; possible routes of infection are mouth-to-mouth, through the common fly or through insufficiently cleaned food. Infections are also more often seen within a family in which one member became infected by the organism. The presence of these bacteria can be diagnosed by your physician either through a simple breath test or by a pathologist identifying the bacteria in the mucosa obtained through a gastroscopy. If Helicobacter pylori have been identified, it is imperative to treat this infection with a multi-drug regimen as soon as possible. Long-standing infection or repeated uncontrollable infections cannot only lead to chronic gastric ulcers, but also to malignant lymphomas (tumors of the white blood cells). There is also an increased risk of developing gastric cancer.
 
Gastritis type C: is generally caused by an overproduction of gastric acid. This overproduction can be caused by permanent physical as well as mental stress; it can also be the result of bile which flows back into the stomach (bile reflux). This is often caused by an insufficiency of the stomach muscle (pylorus), which is supposed to prevent the stomach contents from entering the small intestine before they are sufficiently digested for further transport into the intestinal tract. If the pylorus does not function properly, it causes not only insufficiently digested food to enter the small intestine too early, but also bile to flow back from the small intestine into the stomach where it can cause injury to the stomach lining. A specific diagnosis of this type can, upon clinical suspicion, only be confirmed through a biopsy, taken during the gastroscopy and diagnosed by a pathologist according to the characteristic changes of the lining of the stomach glands.

 
Therapy:
 
The therapy depends on the type of gastritis. Acute gastritis can be treated with light food products, herbal teas and a warm water bottle over 3 to 7 days while abstaining from heavy food, coffee and alcohol.
 
Chronic gastritis, type A treatment consists primarily of vitamin B12 injections.
 
If type B gastritis has been caused by 'Helicobacter pylori' organisms, treatment consists of a combination of one or two antibiotics plus an antacid that blocks the acid secretion. These medications have to be taken for at least 7 to 10 days, and then should be followed up by another gastroscopy and biopsy to assure that there are no more bacteria present. Failure to treat an infection caused by 'Helicobacter pylori' organisms or repeated re-infections which may become difficult to control, can lead to carcinoma of the stomach as well as to a type of lymphoma of the gastric mucosa which may extend well beyond the stomach and cause generalized lymphoma (a 'carcinoma of the lymph nodes'). Other causes of Type B gastritis, including virally associated, are treated with antacids and by treating the underlying cause according to established treatment plans.
 
The treatment of gastritis type C depends on the cause of the acid overproduction; it may consist of acid-blocking drugs (antacids) or, if ulcers have already developed, may need to be treated surgically, either by cutting certain nerves that innervate the gastric gland production or by removing part of the stomach. Successful therapy of gastritis can only be started after the type of gastritis has been properly established. Following this diagnosis, the clinician (General Practitioner or Internist/ Gastroenterologist) will then be able to recommend a therapy that is specifically adjusted to your needs.

 
Prevention:
 
Preventive measurements for acute gastritis include 'conscientious' eating habits, i.e. to adhere to a balanced diet and not to eat irritating food groups which are strongly acid secreting. Hasty eating habits, as well as coffee, tea, alcohol and acid juices on an empty stomach and stress, especially mental stress, can all cause acute gastritis, while some of these habits can also be involved in the development of type C gastritis. Type B gastritis is more difficult to prevent; cleanliness of the food consumed certainly is always recommended, yet this does not assure that you do not become infected by 'Helicobacter pylori' organisms. However, if infected, it is imperative that you seek proper medical treatment to prevent the possibility of progressing towards further more serious ailments (like cancer, lymphoma).

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