GASTRITIS

Cláudio Wolff, MD, Gastroenterology Specialist by the Brazilian Federation of Gastroenterology.
Fábio Segal, MD., Ph. D. in Clinical Medicine by the State University Rio Grande do Sul.
Fernando Wolff, MD.

Also known as stomach inflammation

What is it?

The stomach is a kind of sac that receives what we ingest. Internally, it's lined with a mucosa, a rosy layer resembling that we have in our mouth.

Gastritis is an inflammation of the stomach mucosa, often having a different meaning for lay individuals and doctors.

People frequently use the term gastritis as a complaint, expressing a range of discomforts related to the digestive apparatus.

The doctor, after examining the patient and conducting the necessary tests, either concludes there's presence of gastritis, which many times is asymptomatic, or concludes there's absence of a relevant clinical meaning.

Gastritis can be chronic or acute.

How does it develop?

Acute gastritis

The acute gastritis allows a simpler approach for the reason that its onset occurs suddenly, it courses rapidly, and is easily associated to a causative agent.

Medicaments, infections and physical or psychical stress may lead to acute gastritis.
 

Acetylsalicylic acid (aspirin, AAS), non-steroidal anti-inflammatory agents, corticoids, alcoholic drinks, and the accidental or suicidal ingestion of some corrosive substances are examples of aggressor agents.
Foodstuffs contaminated by germs, such as bacteria, virus, or by their toxins, are a frequent cause to acute stomach inflammation, as part of an infection generally known as acute gastroenteritis.
A widely known condition is the acute upper digestive tract hemorrhage, with vomiting and evacuations with blood.
Digestive hemorrhage can occur as a complication of severe situations like the stress caused by the patient's prolonged stay at the ICU (Intensive Care Unit), in postoperative periods, in patients with large areas of their bodies burned, in multi-traumatized patients, or those with generalized infection (septicemia).

Chronic gastritis

Concerning chronic gastritis, there's also a great deal of confusion, especially as regards the symptoms and the causative agents.
 

Helicobacter pylori bacteria are known to be able to lead to chronic gastritis.
In atrophic chronic gastritis, a condition where the number of cells of the stomach mucosa greatly drops off, there's a considerable reduction in the production of gastric acid, which is important to the "sterilization" of what we ingest and the digestion of food.
At times, the bile released by the liver into the initial portion of the small intestine (duodenum) refluxes to the stomach, causing chronic inflammation.
These factors, acting individually or together, may lead to chronic gastritis.

What does one feel?

Most of the chronic cases don't have symptoms.

When it comes to acute gastritis though, when there are complaints, these vary:
 

burning pain in the abdomen
heartburn
loss of appetite
nausea and vomiting
digestive tract bleeding, in complicated cases, demonstrated by the evacuation of dark stools (melena) and/or vomiting with blood (hematemesis).

Due to deficiency of vitamin B12 and folic acid absorption, there may be anemia manifested by:
 

weakness
sore tongue (glossitis)
irritation on the lip corners
diarrhea
more seldom, neurological changes involving memory, orientation and coherency, a clinical condition related to atrophic gastritis.

How does the doctor accomplish the diagnosis?

In acute gastritis, based on the clinical history, exams being usually unnecessary.

Should complications such as hemorrhage be suspected, high digestive tract endoscopy is the exam indicated. Endoscopy is an examination that allows viewing the mucosa directly, unveiling changes suggestive of some kind of gastritis.

However, 40% of the chronic gastritis cases show nothing.

Hence, the diagnosis of some kinds of gastritis is considered to be essentially histological, that is, it's achieved through the microscopic evaluation of mucosa pieces collected by the biopsy forceps passing through the endoscope.

What's the treatment?

The treatment is related to the causative agent.
 

In the cases of acute gastritis associated to the use of anti-inflammatory drugs, the basic treatment consists of their suspension and/or replacement, in association with the use of drugs that neutralize, inhibit or block the acid secretion from the stomach.
Endoscopy, more frequently employed in cases of acute gastritis accompanied with bleeding, in addition to being able to diagnose, can halt the hemorrhage by applying several local treatments.
There's no consensus about the advantage of treating the Helicobacter pylori bacteria in the presence of gastritis without ulcer, since no significant improvement in the digestive symptoms has been observed.

How to prevent it?
 

Avoiding the use of irritating medicaments, such as anti-inflammatory agents and aspirin.
Avoiding excessive alcoholic drinking and smoking.
There are controversies over the habitual ingestion of coffee and black tea influencing gastritis; hence, their consumption must rely on individual tolerance.
The improvement of sanitary conditions, treatment of domestically used water, personal hygiene (washing the hands before touching food), and of care in food preparation and conservation has made the number of alimentary toxic infection (gastroenteritis) victims plummet.

Questions you can make to your doctor :

Are gastritis and ulcer similar?

Does everyone suffering from gastritis feel the same?

Are there foods that worsen gastritis? What about acid or spicy food?

Is it necessary to treat all types of gastritis?

Does gastritis risk to evolve into something severer?

 

 

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