Gastritis

Gastritis is a term used to describe inflammation of the mucosa (lining) of the stomach.

Gastritis is not a single disease, but a group of disorders that have inflammatory changes in the gastric mucosa in common, but with different clinical features and causes.

There are several classifications of gastritis, but the most commonly used are based on the following:

Acute gastritis

The main form of acute gastritis is called acute haemorrhagic, or acute erosive, gastritis. This reflects the fact that in this form of the disease there is bleeding from the gastric mucosa. The mucosa also erodes as a result of the associated inflammation.

Chronic gastritis

Chronic gastritis is a different entity to acute gastritis.

It does not usually cause symptoms, but may be associated with an anaemia called pernicious anaemia.  In this form of gastritis, vitamin B12 is not absorbed because of lack of secretion by the stomach wall.

Cause of acute haemorrhagic gastritis

This type of gastritis can develop for no apparent reason. However, it is more likely to be associated with:

• Drugs such as aspirin and other non-steroidal anti-inflammatories
• Drugs such as some antibiotics and chemotherapy
• Alcohol abuse
• Post radiation therapy

Signs and symptoms

Bleeding from the gastric mucosa in acute gastritis can occasionally result in sudden and dramatic blood loss or haemorrhage. Obvious symptoms and signs include:

• Vomiting blood – which often appears as altered blood, looking like “coffee grounds”
• Passing blood in the stools – again as altered blood resulting in foul-smelling, black, tarry stools. These are called melaena stools.

Less common symptoms and signs include:

• Pain in the upper part of the abdomen
• Nausea
• Vomiting

Pain is much less common in acute haemorrhagic gastritis than in ulcer disease.

A physical examination is usually normal in patients with acute haemorrhagic gastritis.
It may show:

• Tenderness in the upper part of the abdomen
• Evidence of blood loss in that the patient is pale, has a fast heart beat (tachycardia) and low blood pressure

Diagnosis

The presence of bleeding is usually first suspected after blood has been detected in the stool or vomitus.

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 changes that are characteristic of the condition.

Treatment

Treatment should focus on:

• Preventing the development of haemorrhagic gastritis – this is done by giving hourly antacids to severely ill patients, stopping offending drugs and limiting alcohol intake
• Treating the associated disease
• Withdrawal of any offending drug, such as non-steroidal anti-inflammatories
• General supportive measures in the case of severe haemorrhage. These include maintenance of oxygen, blood volume (by transfusion where necessary) as well as fluid and electrolyte requirements.

Outcome

The mortality may be high in the elderly and in patients who have bled very heavily.

Less severe forms of the illness respond well to measures such as regular antacids, correction of blood and fluid volume and general supportive measures.

When to call your doctor

If you or any member of your family develops any of the symptoms listed above, seek medical advice. In general, a doctor should be seen as a matter of urgency if any of the following symptoms 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

^{Revised and reviewed by Dr John P Wright MBChB, MRCP (UK), PhD. Gastroenterologist in private practice, Cape Town. February 2015}