Gastritis Health Article

Definition

Gastritis commonly refers to inflammation of the lining of the stomach, but the term is often used to encompass a variety of symptoms resulting from stomach lining inflammation, as well as symptoms of burning or discomfort. True gastritis comes in several forms and is diagnosed using a combination of tests. In the 1990s scientists discovered that the main cause of true gastritis is infection from a bacterium called Helicobacter pylori (H. pylori).

Description

Gastritis should not be confused with common symptoms of upper abdominal discomfort. Gastritis has been associated with resulting ulcers, particularly peptic ulcers. In some cases, chronic gastritis can lead to more serious complications.

Nonerosive Helicobacter pylori (H. pylori) gastritis

The main cause of true gastritis is H. pylori infection. H. pylori is indicated in an average of 90% of persons with chronic gastritis. This form of nonerosive gastritis is the result of infection with the H. pylori bacterium, a microorganism whose outer layer is resistant to the normal effects of stomach acid in breaking down bacteria. This resistance means that the bacterium may rest in the stomach for long periods of times, even years, and eventually cause symptoms of gastritis or ulcers when other factors are introduced, such as the ingestion of nonsteroidal antiinflammatory drugs (NSAIDs). It also seems to be activated in people with a genetic predisposition. Study of the role of H. pylori in development of gastritis and peptic ulcers has disproved the former belief that stress led to most stomach and duodenal ulcers. This understanding has resulted in improved treatment and reduction of stomach ulcers. H. pylori is most likely transmitted between humans, although the specific routes of transmission were still under study in 2001. Studies are also underway to determine the role of H. pylori and resulting chronic gastritis in the development of gastric cancer.

Erosive and hemorrhagic gastritis

The most common cause of this form of gastritis is use of NSAIDs. Other causes may be alcoholism, or stress from surgery or critical illness. The role of NSAIDs in development of gastritis and peptic ulcers depends upon the dosage level. Although even low doses of aspirin or other NSAIDs may cause some gastric upset, such low doses generally will not lead to gastritis. However, as many as 10%–30% of persons on higher and more frequent doses of NSAIDs, such as those with chronic arthritis, may develop gastric ulcers. As of 2001, studies were underway to determine the role of H. pylori in gastritis and ulcers among persons using NSAIDs.

Individuals with erosive gastritis may also experience no symptoms. When symptoms do occur, they may include anorexia nervosa, gastric pain, nausea, and vomiting.

Other forms of gastritis

Specific treatment will depend upon the cause and type of gastritis. These may include prednisone or antibiotics.

Nonerosive H. pylori gastritis

H. pylori gastritis is caused by infection from the H. pylori bacterium. It is believed that most infection occurs in childhood. The route of its transmission was still under study in 2001 and clinicians assume there may be more than one route for the bacterium to enter a body. Its prevalence and distribution differ in nations around the world. The presence of H. pylori has been detected in between 86% and 99% of persons with chronic superficial gastritis. However, physicians are still learning about the link between H. pylori and chronic gastritis and peptic ulcers, since many persons with H. pylori infection do not develop symptoms of gastritis or peptic ulcers. H. pylori is also seen in approximately 90% to 100% of people with duodenal ulcers.

Symptoms of H. pylori gastritis include abdominal pain and reduced acid secretion in the stomach. However, the majority of people with H. pylori infection suffer no symptoms, even though the infection may lead to ulcers and resulting problems. Ulcer symptoms include dull, gnawing pain, often two to three hours after meals, and pain in the middle of the night when the stomach is empty.

Nonerosive H. pylorigastritis

H. pylori gastritis is easily diagnosed through the use of the urea breath test. This test detects the active presence of H. pylori infection. Other serological tests, which may be readily available in a physician's office, may be used to detect H. pylori infection. Newly developed versions offer rapid diagnosis. The choice of test will depend upon cost, availability, and the physician's experience, since nearly all of the available tests have an accuracy rate of 90% or better. Endoscopy, or the examination of the stomach area using a hollow tube inserted through the mouth, may be ordered to confirm diagnosis. A biopsy of the gastric lining may also be ordered.

Erosive or hemorrhagic gastritis

The patient's clinical history may be particularly important in the diagnosis of this type of gastritis, since its cause is most often the result of chronic use of NSAIDs, alcohol, or other erosive substances.