Gastritis

Gastritis can be defined as an inflammation and irritation of the lining of the stomach. It is also referred to as wind, gastroenteritis and gastric ulcers all referring to this condition. There are two types of gastritis: acute and chronic. Acute Gastritis is the inflammation of the stomach mucosa, accompanied by the formation of granular nodules, and hemorrhage. The term "acute" means that the attacks are short, not necessarily that the symptoms are severe. Chronic Gastritis refers to prolonged inflammation, as there is a growth of fibrous tissue on the lining. People with chronic gastritis may have no pain but may experience other symptoms. Chronic gastritis is further subdivided into type A and B.

Chronic gastritis may be a symptomatic till the end when the condition has progressed extensively. Other symptoms would include the following

Control of risk factors may minimize the onset of acute gastritis. Medications that cause gastritis, such as aspirin or NSAIDs should be discontinued as a preventive measure for chronic gastritis.

Acute gastritis is often associated with a severe, acute illness, or trauma and may result from medications, alcohol, ingestion of corrosive substances, various infections ranging from syphilis and tuberculosis to fungus or extreme physiological stress . The risk factors would include nonsteroidal anti-inflammatory drug use (NSAIDs), recent heavy alcohol use , or physiological stress such a major surgery, head trauma , renal failure , liver failure and respiratory failure. The incidence is 8 out of 1,000 people. Chronic gastritis may be classified as TYPE A resulting from pernicious anemia, an autoimmune disorder, TYPE B resulting from an infection with the bacteria, in which case it is associated with diet, smoking, alcohol & reflux. It can also come about by prolonged irritation from the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The condition is asymptomatic and would include a history of pernicious anemia, blood or lymph system disorders, age over 60 years and use of NSAIDs as risk factors associated with it. The incidence is 2 out of 10,000 people.

The understanding of gastritis (inflammatory changes in gastric mucosa) has changed dramatically over the last 15 years. The symptoms remain the same but we are now able to separate causes on the basis of a histological pattern giving us an understanding of the aetiology of the condition (vida infra). This has allowed the clinician to implement the correct treatment.
Infective Gastritis Infection is the commonest cause of gastritis and by far the commonest organism is Helicobacter pylori. Infection by the organism is generally thought to occur in childhood. This organism is visible under the light microscope and is almost always associated with some degree of inflammation of the underlying mucosa. It has been associated with the development of duodenal ulcer, gastric carcinoma and gastric lymphoma. More recent concerns involve the long-term treatment with Omeprazole. There is some evidence to suggest that patients on this therapy and who are H.pylori positive have a greater risk of developing atrophic gastritis, which recognized as being a precursor to gastric carcinoma. Other infective agents such as Gastrospirillum hominis can also be demonstrated by histological examination. This is a rare organism that is larger than H.pylori and is a common organism of domestic animals. Viral gastritis is more common in immunosuppressed patients as are mycobacterial infections. Both these are relatively rare in the community. Many other organisms can also cause gastritis but these are extremely uncommon. Follow up biopsy after treatment for H.pylori is becoming more common. It is recognized there is poor correlation between endoscopic appearances and histological findings. The role of the pathologist is to assess the presence or absence of H.pylori. If chronic inflammation persists this may herald regrowth of the bacteria.
Chemical Gastritis This has a classic histological appearance characterized by lamina propria oedema and elongation of the epithelium associated with minimal inflammation. Common causes for this are non-steroidal anti-inflammatory agents, a variety of other drugs and bile reflux. Interestingly, non-steroidal anti-inflammatory ingestion appears to suppress H.pylori growth a mixed pattern is recognized where we see a combination of chemical and H.pylori gastritis.
Vascular Gastritis Occasionally the antrum is described as being red at the time of endoscopy and there is no histological abnormality. This may be a reflection on the normal vascular pattern giving a hyperaemic appearance. Portal hypertension results in vascular ectasia of the mucosal vessels and can give rise to a red stomach.
Inflammatory Gastritis This is a waste box of inflammatory conditions. One of the most interesting is lymphocytic gastritis. This entity is well recognized in Europe but not really appreciated in the English-speaking world. It is associated with a classic endoscopic appearance of oedematous mucosal folds, which bleed easily. It may involve the antrum, the body or the whole stomach. It has a classic histological appearance. It is of unknown aetiology but is linked to protein losing enteropathies and coeliac disease like changes in the small bowel. It is not believed to be a pre malignant condition. We have seen three cases associated with gastric carcinoma, in our series of 70, in 24 months. This may be a fortuitous association. Biopsies that demonstrate inflammation but no evidence of organisms can be lumped under the inflammatory banner but these are a mixed group and some possibly represent unknown infections. Granulomatous gastritis is a rare condition and Crohns disease and mycobacterial infection must be excluded.

A poor diet with too many fried foods, fatty foods, sugars and refined foods, poor food combinations, and drinking with meals all cause gastritis. It is better to stick to a simple diet consisting of fruits and vegetables.

Taking rest when this condition occurs is the best. Besides doing exercise and having an active routine also helps get rid of gastritis.

• Frequently linked to anxiety and stress, herbs that help to calm the central nervous system may be of great value.
• Individuals with this condition often internalize stress and are people pleasers, perfectionists, and live life at a fast pace. Learning to take things easy may be helpful.
• People with weak bowels can experience stress in the form of chronic diarrhea, constipation, stomach bloating and continual inflammation.
• Learning to handle stress and meditate, along with tackling emotional issues, if any, is very important.