Gastritis
Gastritis is an inflammation of the lining of the stomach. There are several forms, including chronic gastritis (symptoms are usually indefinite or nonexistent) and acute erosive gastritis (symptoms may include vomiting, vomiting blood, black, tarry feces, anorexia nervosa, and nausea).
In the 1990s, scientists discovered that the main cause of chronic gastritis is infection from a bacterium called Helicobacter pylori (H. pylori). This micro-organism has an outer layer that is resistant to the normal effects of stomach acid in breaking down bacteria, so it may rest in the stomach for long periods, even years, causing symptoms of gastritis or ulcers when other factors are introduced, such as the presence of specific genes or ingestion of nonsteroidal anti-inflammatory drugs (NSAIDS). Study of the role of H. pylori in gastritis and peptic ulcers has disproved the former belief that stress led to most stomach and duodenal ulcers. H. pylori is most likely transmitted between humans, although the specific routes of transmission are not fully understood. As the millennium closed, studies were also underway to determine the role of H. pylori and resulting chronic gastritis in gastric cancer.
After H. pylori, the second most common cause of gastritis is nonsteroidal anti-inflammatory drugs. These commonly used pain killers, including aspirin, fenoprofen, ibuprofen and naproxen, can lead to acute erosive gastritis and peptic ulcers. Other forms of erosive gastritis can be caused by alcohol and corrosive agents or due to trauma such as ingesting foreign bodies. Patients with erosive gastritis sometimes show no symptoms.
Other types of gastritis include:
- Acute stress gastritis—this most serious form of gastritis usually occurs in critically ill patients.
- Atrophic gastritis results from chronic gastritis that is leading to wasting away of the stomach's lining. Gastric atrophy is the final stage of chronic gastritis and may be a forerunner to gastric cancer.
- Superficial gastritis is a term used to describe the initial stages of chronic gastritis.
- Uncommon specific forms of gastritis include granulomatous, eosiniphilic and lymphocytic gastritis.
Less common forms of gastritis may result from a number of generalized diseases or from complications of chronic gastritis.
Chronic gastritis is easily diagnosed with the urea breath test, which detects H. pylori infection, or through blood tests or endoscopy (examining the stomach area using a hollow tube inserted through the mouth). A biopsy of the stomach lining may also be ordered.
Diagnosis of acute erosive gastritis involves careful questioning of the patient, since this type of gastritis is most often the result of chronic use of NSAIDS, alcoholism, or other substances.
The discovery of H. pylori's role in gastritis and ulcers has led to improved treatment of chronic gastritis. Since the infection can be treated with antibiotics, the bacterium can be completely eliminated up to 90% of the time. Although H. pylori can be successfully treated, the treatment may be uncomfortable for patients and relies heavily on patient compliance. No single antibiotic has been found to eliminate H. pylori on its own, so a combination of antibiotics is usually prescribed.
In acute erosive gastritis, few patients show symptoms, so treatment may depend on severity of symptoms. When symptoms do occur, patients may be treated with therapy similar to that for H. pylori, especially since some studies have demonstrated a link between H. pylori and NSAIDS in causing ulcers. Avoidance of NSAIDS will most likely be recommended.
For other forms of gastritis, specific treatments will depend on the cause and type of gastritis, and may include prednisone or antibiotics. Critically ill patients at high risk for bleeding may be treated with preventive drugs to reduce risk of acute stress gastritis. If stress gastritis does occur, the patient is treated with a drug to stop bleeding. Sometimes surgery is recommended, but is weighed with the possibility of surgical complications or death. Once torrential bleeding occurs in acute stress gastritis, the death rate can be greater than 60%.
Alternative forms of treatment for gastritis and ulcers should be used cautiously and in conjunction with conventional medical care, particularly now that scientists have confirmed the role of H. pylori in gastritis and ulcers. Alternative treatments address gastritis symptoms with diet and nutritional supplements, herbal medicine and ayurvedic medicine. It is believed that zinc, vitamin A and beta-carotene aid the stomach lining's ability to repair itself. Herbs thought to stimulate the immune system and reduce inflammation include echinacea (Echinacea) and goldenseal (Hydrastis canadensis).
The discovery of H. pylori has improved the prospects of recovery for patients with gastritis and ulcers. Research is continuing into the most effective treatment of H. pylori, especially in light of the bacterium's resistance to certain antibiotics. It is believed that H. pylori plays a role in the eventual development of serious gastritis complications and cancer. Detection and treatment of H. pylori infection may help reduce occurrence of these diseases. The prospects for patients with acute stress gastritis are much poorer, with a 60 percent or higher death rate among those bleeding heavily.
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