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Gastritis is not a single disease. It is a general term used to describe a group of disorders, with different clinical features and causes, that produce inflammation of the mucosa (lining) of the stomach. The two main forms of gastritis are acute (sudden) and chronic (persistent):
Acute gastritis
The main form of acute gastritis is called acute haemorrhagic, or acute erosive, gastritis. In this type of disease, there is bleeding from the gastric mucosa. The mucosa also erodes as a result of inflammation.
Acute gastritis can develop for no apparent reason. However, it tends to be associated with:
• Patients in medical or surgical intensive care who have suffered severe trauma, major surgery, massive shock, burns, failure of the respiratory, kidney or liver systems, or severe infection with septicaemia. In these cases it is sometimes called stress-induced gastritis.
• Drugs such as aspirin and other non-steroidal anti-inflammatories
• Increased production of bile acids, or of digestive enzymes from the pancreas
• Alcohol abuse
Acute gastritis can result in sudden and dramatic blood loss or haemorrhage. It can also cause subtle bleeding, which may be detectable only by examining the stool for blood, or if the person develops mild and otherwise unexplained anaemia.
Obvious symptoms are:
• Vomiting blood – which often appears altered, typically looking like “coffee grounds”
• Blood in the stools – again, this is “altered” blood, resulting in foul-smelling, black, tarry stools. These are called melaena stools.
Less common signs include nausea, vomiting and abdominal pain (although pain is much less common in acute haemorrhagic gastritis than in ulcer disease).
If there is blood in stools or vomit, a physical examination may further show:
• Tenderness in the upper part of the abdomen
• Paleness, a fast heart beat (tachycardia) and low blood pressure (evidence of blood loss)
The diagnosis is established by examining the stomach with a flexible fibre-optic endoscope, through which the specialist can see haemorrhage in the mucosa and other characteristic changes.
Treatment involves:
• Hourly antacids for severely ill patients
• Limiting alcohol intake
• Treating any associated disease
• Withdrawing any drug that may contribute to the gastritis, such as non-steroidal anti-inflammatories
• In the case of severe haemorrhage, general supportive measures: maintenance of oxygen, blood volume (by transfusion if necessary) and fluid and electrolyte requirements
In the rare cases where the patient has bled very heavily, mortality is high – generally more than 60%. However, less severe forms of the illness respond well to treatment.
Chronic gastritis
In chronic gastritis, the inflammation in the stomach is caused by specific inflammatory cells. It is often patchy and irregular in distribution. Secretion of acid in the stomach is reduced, which contributes to the inflammation.
Chronic gastritis has been divided into two major forms:
• Type A chronic gastritis is less common. It characteristically involves only two parts of the stomach, the fundus and the larger, lower portion.
This is the form of gastritis that can lead to pernicious anaemia, a form of anaemia involving a deficiency of vitamin B12. This is a result of the body’s failure to produce a substance called intrinsic factor, which allows the absorption of vitamin B12 from the gut.
• Type B gastritis is much more common. In younger patients, this type of chronic gastritis usually involves only a part of the stomach called the antrum. In older patients the entire stomach is affected.
There is a strong association of the bacterium Helicobacter pylori with type B gastritis. Eradication of H. pylori counteracts the structural changes in the gut that are associated with this type of gastritis. When treatment is stopped, the bacteria reappear and the changes recur.
There is no good evidence that acute gastritis, when it is associated with stress, alcohol or non-steroidal anti-inflammatory drugs, leads to chronic gastritis. However, acute gastritis caused by H. pylori may lead to type B chronic gastritis over time.
Chronic gastritis is diagnosed by biopsy of the gastric mucosa. This involves using a fibre-optic endoscope to view the inside of the stomach. A small sample of the mucosa is then clipped off, stained and examined under a microscope.
Pernicious anaemia requires life-long replacement of vitamin B12. Apart from this, there is no specific treatment for chronic gastritis.
Uncommon types of gastritis
• Ménétrier’s disease: This disease of unknown cause results in very large, thick folds in the mucosa of the stomach. It generally affects adults aged between 30 and 60. It is usually chronic, but can clear up by itself. The symptoms may include loss of appetite, pain in the upper part of the abdomen and swelling around the eyes and in the legs. The disease causes loss of protein in the serum – the watery part of the blood.
• Eosinophilic gastritis: This is a condition in which there is extensive infiltration of the gastric mucosa with cells called eosinophils. These are cells produced by the immune system in response to foreign bodies present in the body. This often results from severe infestation with parasitic nematode worms.
• Gastritis with physical causes: These include ingestion of corrosive materials and radiation. Infectious (septic) gastritis can develop after this kind of damage. Bacteria invade the inflamed mucosa, causing a serious illness that may result in death.
• Other causes: People who are debilitated by cancer or HIV may develop viral or fungal gastritis, becoming infected with Candida, histoplasmosis, cytomegalovirus or mucormycosis.
When to call your doctor
If you or any member of your family develop any of the symptoms listed above, seek medical advice. A doctor should be seen as a matter of urgency if any of the following develop:
• Vomiting “coffee ground” liquid
• Passing foul-smelling, tarry, black stools
• Severe upper abdominal pain, with vomiting and nausea
• Chronic fatigue, loss of appetite and swelling around the eyes or in the legs
Acute gastritis
The main form of acute gastritis is called acute haemorrhagic, or acute erosive, gastritis. In this type of disease, there is bleeding from the gastric mucosa. The mucosa also erodes as a result of inflammation.
Acute gastritis can develop for no apparent reason. However, it tends to be associated with:
• Patients in medical or surgical intensive care who have suffered severe trauma, major surgery, massive shock, burns, failure of the respiratory, kidney or liver systems, or severe infection with septicaemia. In these cases it is sometimes called stress-induced gastritis.
• Drugs such as aspirin and other non-steroidal anti-inflammatories
• Increased production of bile acids, or of digestive enzymes from the pancreas
• Alcohol abuse
Acute gastritis can result in sudden and dramatic blood loss or haemorrhage. It can also cause subtle bleeding, which may be detectable only by examining the stool for blood, or if the person develops mild and otherwise unexplained anaemia.
Obvious symptoms are:
• Vomiting blood – which often appears altered, typically looking like “coffee grounds”
• Blood in the stools – again, this is “altered” blood, resulting in foul-smelling, black, tarry stools. These are called melaena stools.
Less common signs include nausea, vomiting and abdominal pain (although pain is much less common in acute haemorrhagic gastritis than in ulcer disease).
If there is blood in stools or vomit, a physical examination may further show:
• Tenderness in the upper part of the abdomen
• Paleness, a fast heart beat (tachycardia) and low blood pressure (evidence of blood loss)
The diagnosis is established by examining the stomach with a flexible fibre-optic endoscope, through which the specialist can see haemorrhage in the mucosa and other characteristic changes.
Treatment involves:
• Hourly antacids for severely ill patients
• Limiting alcohol intake
• Treating any associated disease
• Withdrawing any drug that may contribute to the gastritis, such as non-steroidal anti-inflammatories
• In the case of severe haemorrhage, general supportive measures: maintenance of oxygen, blood volume (by transfusion if necessary) and fluid and electrolyte requirements
In the rare cases where the patient has bled very heavily, mortality is high – generally more than 60%. However, less severe forms of the illness respond well to treatment.
Chronic gastritis
In chronic gastritis, the inflammation in the stomach is caused by specific inflammatory cells. It is often patchy and irregular in distribution. Secretion of acid in the stomach is reduced, which contributes to the inflammation.
Chronic gastritis has been divided into two major forms:
• Type A chronic gastritis is less common. It characteristically involves only two parts of the stomach, the fundus and the larger, lower portion.
This is the form of gastritis that can lead to pernicious anaemia, a form of anaemia involving a deficiency of vitamin B12. This is a result of the body’s failure to produce a substance called intrinsic factor, which allows the absorption of vitamin B12 from the gut.
• Type B gastritis is much more common. In younger patients, this type of chronic gastritis usually involves only a part of the stomach called the antrum. In older patients the entire stomach is affected.
There is a strong association of the bacterium Helicobacter pylori with type B gastritis. Eradication of H. pylori counteracts the structural changes in the gut that are associated with this type of gastritis. When treatment is stopped, the bacteria reappear and the changes recur.
There is no good evidence that acute gastritis, when it is associated with stress, alcohol or non-steroidal anti-inflammatory drugs, leads to chronic gastritis. However, acute gastritis caused by H. pylori may lead to type B chronic gastritis over time.
Chronic gastritis is diagnosed by biopsy of the gastric mucosa. This involves using a fibre-optic endoscope to view the inside of the stomach. A small sample of the mucosa is then clipped off, stained and examined under a microscope.
Pernicious anaemia requires life-long replacement of vitamin B12. Apart from this, there is no specific treatment for chronic gastritis.
Uncommon types of gastritis
• Ménétrier’s disease: This disease of unknown cause results in very large, thick folds in the mucosa of the stomach. It generally affects adults aged between 30 and 60. It is usually chronic, but can clear up by itself. The symptoms may include loss of appetite, pain in the upper part of the abdomen and swelling around the eyes and in the legs. The disease causes loss of protein in the serum – the watery part of the blood.
• Eosinophilic gastritis: This is a condition in which there is extensive infiltration of the gastric mucosa with cells called eosinophils. These are cells produced by the immune system in response to foreign bodies present in the body. This often results from severe infestation with parasitic nematode worms.
• Gastritis with physical causes: These include ingestion of corrosive materials and radiation. Infectious (septic) gastritis can develop after this kind of damage. Bacteria invade the inflamed mucosa, causing a serious illness that may result in death.
• Other causes: People who are debilitated by cancer or HIV may develop viral or fungal gastritis, becoming infected with Candida, histoplasmosis, cytomegalovirus or mucormycosis.
When to call your doctor
If you or any member of your family develop any of the symptoms listed above, seek medical advice. A doctor should be seen as a matter of urgency if any of the following develop:
• Vomiting “coffee ground” liquid
• Passing foul-smelling, tarry, black stools
• Severe upper abdominal pain, with vomiting and nausea
• Chronic fatigue, loss of appetite and swelling around the eyes or in the legs
