Symptoms, Diagnosis and Treatment of Gastritis

The food we consume is digested by acids and digestive enzymes present in the stomach. A thin layer of mucous lines the stomach wall so that the acids and enzymes do not attack or digest the stomach tissue. However, in some people, this lining of the stomach wall gets inflamed, irritated or eroded due to various reasons. The condition is called Gastritis.

While a mild bout of gastritis can happen to anybody, at any age, and is not a cause for concern, it gets serious when there is a sudden and severe bout – called as acute gastritis, or when there is slow and gradual development of gastritis over time – called as chronic gastritis. Further, these 2 types can be either erosive or non-erosive gastritis. Erosive gastritis, as the name implies, erodes the lining of the stomach wall and is more serious. In non-erosive gastritis, the stomach lining stays intact but goes through biochemical changes which can affect your health in different ways.

All the above types of gastritis need quick diagnosis and treatment. If left untreated or ignored, Gastritis can cause complications such as Vitamin B12 deficiency, iron deficiency (anaemia), stomach ulcers and stomach cancer.

Causes and Risk Factors

• Bacterial infection - caused by Helicobacter pylori (H pylori) is the most common type of gastritis.
• Chemical irritants – Non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen used as pain-killers is known to cause gastritis.
• Auto-immune disorders: In auto-immune atrophic gastritis, the body’s immune system attacks the lining of the stomach wall. Hashimoto’s disease and type-1 diabetes are two such auto-immune disorders that can trigger this condition.
• Physical injury: Physical injury to stomach or a surgery in the stomach for different reasons can cause trauma to the stomach lining. The latter condition is called post-gastrectomy gastritis and is caused by bile reflux in the stomach.
• Non-bacterial infections: Other than bacteria, some viruses and fungi can also cause gastritis, especially if the person is suffering from an auto-immune disorder or a long-term illness.
• Radiation: Radiation given for treating cancers of the abdomen, or contamination from radioactive material can induce gastritis
• Eosinophilic gastritis: Allergens in the food or air can trigger a bout of allergic gastritis
• Celiac disease: An immune response to eating a gluten-rich diet, characterised by bloating, diarrhoea, anaemia, flatulence and osteoporosis.
• Menetrier disease: Here, thick folds and cysts develop on the stomach-wall triggering gastritis.
• HIV: Human immunodeficiency virus transmitted by infected blood, semen and vaginal fluids can trigger gastritis.
• Crohn’s disease: A chronic inflammatory bowel condition
• Chemotherapy given for treating cancers of the abdomen
• Regular use of prescription steroids for one or more ailments
• Potassium and iron supplements
• Vitamin B12 deficiency
• Smoking
• High levels of stress
• Alcohol or cocaine abuse
• Swallowing a foreign object or any corrosive substance
• A history of vomiting and nausea

Symptoms

• Shortness of breath (dyspnea)
• Chest pain
• Rapid or racing heartbeat (palpitations)
• Excessive sweating without reason
• Severe stomach pain
• Abdominal pain with a fever
• Bloated abdomen or feeling full
• Repeated bouts of hiccups
• Indigestion
• Burning sensation in an empty stomach
• Vomit that contains blood
• A large amount of yellow or green vomit
• Vomit that contains dark material that look like coffee-grounds
• Foul-smelling stools
• Black or bloody stools
• Dizziness and fainting

Diagnosis

Diagnosing Gastritis involves testing one or more organs in the abdomen. Some of the tests that will be conducted are:

• General physical examination and reviewing current symptoms
• Review of the person’s and family medical history
• Tests to detect H. pylori in the blood, breath and stools
• Upper endoscopy: An endoscope is passed through the mouth and into the stomach to look at the lining of the stomach wall
• Biopsy: Endoscopy may be followed by a biopsy of the stomach-wall lining
• Electrocardiography: ECG and EKG tests
• Barium swallow: A solution containing barium is consumed by the person. Then, on a monitor, a doctor watches images of the oesophagus, stomach, and small intestine.
• Function Test of the kidney, liver, gall bladder and pancreas
• Blood test to check for anaemia and H pylori
• Pregnancy test if relevant
• Faecal occult test or stools test to check for presence of blood

Treatment

• Antibiotics: This addresses gastritis caused by H pylori. The patient is prescribed a single course of clarithromycin and/or metronidazole.
• Proton pump inhibitors: These drugs block the cells that produce acid in the stomach and help heal gastritis. Examples of these are omeprazole, lansoprazole and esomeprazole
• H2 blockers: Drugs such as Famotidine help reduce the acid produced by the stomach and help overcome gastritis
• Antacids: These drugs neutralize the acid in the stomach and are available as over-the-counter medicines.
• Coating agents: Drugs such as sucralfate or misoprostol coat the lining of the stomach wall and protect it from secretions in the stomach.
• Anti-nausea medications: These address the symptoms of gastritis more than the cause.
• Vitamin B12 if the gastritis is caused by pernicious anaemia
• Eliminating foods that irritate the stomach, such as hot and spicy food, lactose from dairy and gluten from wheat or wheat derivatives, from the diet

Outlook

Reputed hospitals have some of the best gastroenterologists in town, on their rolls. These specialists will diagnose the exact nature and extent of gastritis and then put you on a course of treatment for quick recovery and rehabilitation.

Dr Mahadevan B

HOD & Senior Consultant – Department of Gastroenterology & Endosonography