Posted On : 06/03/2022 03:04
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Gastritis is among the common diseases of stomach in the general population… Although this condition is sometimes regarded as “a simple stomach ache” and ignored, it may lead to serious problems. What is gastritis? Gastritis implies acute or chronic inflammatory changes in the mucosa or the innermost lining of the stomach due to many factors and causes.
Many factors may lead to the onset of gastritis. These are:
* Short- or long-term use of various drugs (pain killers, iron supplements, cholchicine, cocaine and chemotherapeutic agents such as mytomicin fluorouracil and floxuridine),
* Some alcoholic drinks (Whisky, gin, vodka etc.),
* Bacterial infections (Helicobacter pylori is the most common and significant causative agent, but other rare bacteria include Helicobacter heilmannii, streptococci and staphylococci, Proteus species, Clostridium species, tuberculosis and syphilis),
* Viral infections (for example, Cytomegalovirus infections),
* Fungal infections (For example, Candida infections),
* Parasitic infestations (For example, Strongyloides, Schistosoma),
* Acute stress (Shock conditions),
* Exposure to radiation,
* Allergy or food intoxications,
* Increased biliary content in the stomach (diseases of bile ducts and gallbladder),
* Poor blood supply to the stomach due to various reasons (ischemia),
* Autoimmune etiology (autoimmune gastritis),
* Diseases that form granuloma (Crohn’s disease, sarcoidosis, foreign bodies, vasculitis, lymphoma and various infections – tuberculosis, histoplasmosis, mucormycosis, blastomycosis),
* Diseases that cause lymphocytosis (lymphocytic gastritis and Celiac disease),
* Allergic conditions (eosinophilic gastritis).
Gastritis can be classified as acute or chronic gastritis depending on the onset and persistence of the complaints. If the gastric complaints develop suddenly secondary to an inflammatory etiology, the condition is usually an acute gastritis (it is commonly caused by infections, use of medicines and ischemia).
If the inflammatory etiology continues destruction of the gastric mucosa for a long interval, the condition is called chronic gastritis. Chronic gastritis is classified according to the underlying cause such as Helicobacter pylori gastritis, alkaline gastritis caused by bile reflux, drug-induced gastritis, autoimmune gastritis and allergic gastritis. Gastritis is also classified according to the pathological findings, such as lymphocytic gastritis, atrophic gastritis and eosinophilic gastritis. Another classification is based on the endoscopic appearance and the damaged part of the stomach. These are called antral gastritis, pangastritis (if the stomach is entirely involved), varioliform gastritis and erosive gastritis. However, one should always remember that ‘gastritis’ is a pathological definition or in other words, diagnosis of gastritis is established when the cellular damage in the gastric mucosa is seen under microscope.
Most common signs of gastritis are epigastric burn, bleeding and pain. Bloating, nausea and vomiting are also likely. Gastric complaints are usually aggravated by eating and therefore, the patient becomes beware of eating. The physical examination by the physician is usually unremarkable, but mild epigastric tenderness can be detected. If complications of gastritis have already developed (peptic ulcer secondary to Helicobacter pylori infection, stomach cancer or gastric lymphoma), signs and symptoms may exacerbate. Atrophic gastritis may cause Vitamin B12 deficiency and signs and symptoms of the deficiency may emerge before the gastritis-related complaints (hematological or neurological signs; skin rashes, anemia, tinnitus, vertigo, palpitation, chest pain or heart failure, feeling of burn in tongue, numbed arms and feet and impaired memory). Endoscopic examination may demonstrate hyperemia, small round or linear superficial wounds (erosions) and edema in the gastric pili)
Medication treatment is started for gastritis, if required. Excluding Helicobacter pylori infection, there is no specific treatment for acute gastritis. Medical treatment should be started and planned according to the underlying cause and the pathological findings. Surgical treatment is extremely rare in gastritis.
The principal goal of the medical treatment is the management of the underlying disease; gastric acid secretion should be reduced with drugs to give the gastric mucosa a chance of healing. However, reduction of the gastric acid secretion will not help the gastritis secondary to the bile reflux (alkaline gastritis) or cases of normal or low gastric secretion (atrophic gastritis). The causes that increase the secretion of gastric should be treated in all patients, if possible (avoiding the foods and drinks that increase secretion of the gastric acid; cessation of certain drugs, such as painkiller, if possible; reducing or stopping alcohol consumption; alleviating the stress).
If Helicobacter pylori infection is detected, multi-drug antibiotherapy is the most commonly recommended medical treatment. If Helicobacter pylori are not identified, proton pump inhibitors, H2 receptor blockers and anti-acid medicines are recommended that suppress the gastric acid production or reduces the concentration of acid in the stomach. However, interaction of drugs that suppress production of gastric acid with other drugs should be taken into consideration, when such treatments are recommended (especially patients who continuously take anticoagulants (such as Clopidogrel) for cardiac or chronic rheumatoid diseases).
Balanced electrolyte solutions are also recommended to manage the electrolyte imbalances that are secondary to vomiting in acute gastritis. If the causative infectious agent is identified that caused the onset of gastritis, antibiotic agent, anti-parasitic agent or antifungal agent is started depending on the cause of the infection.
If the gastritis is caused by Helicobacter pylori infection and it is left untreated (especially patients with family history positive for chronic gastric complaints or stomach cancer), complications of chronic Helicobacter pylori infection may emerge, such as peptic ulcer, atrophic gastritis and stomach cancer, over years. If the patient has no response to drugs that suppress acid secretion, further examinations should be considered to detect the underlying cause. Otherwise, chronic bacterial, viral or parasitic infections may lead to complications, such as vitamin deficiencies and anemia.
Healthy, clean and regular eating is a must and certain foods should be avoided that increase the production of gastric acid, such as too spicy foods, sour sauces, acidic fruits, fizzy drinks, alcohol, fried foods and fatty meals. Smoking should be decreased or stopped. Stressful life conditions should be avoided, if possible. Painkillers should not be taken as long as it is possible, but patients should contact their physicians to protect the stomach, if they are necessarily taken. If Helicobacter pylori infection or gastric complications of the infection (peptic ulcer, atrophic gastritis, stomach cancer and gastric lymphoma) are detected and the patient’s family history is notable for the stomach cancer, it is strongly recommended that treatment of Helicobacter pylori infection is followed by regular doctor visits and endoscopic examination.
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