Gastritis
Sutter Davis Hospital Gastroenterology

Definition
Gastritis commonly refers to inflammation of the lining of the stomach, but the term is often used to cover a variety of symptoms resulting from stomach lining inflammation and symptoms of burning or discomfort. True gastritis comes in several forms and is diagnosed using a combination of tests. The main cause of true gastritis is infection from a bacterium called Helicobacter pylori (H. pylori).

Types of Gastritis

• Nonerosive H. pylori gastritis - The main cause of true gastritis is H. pylori infection. H. pylori is indicated in an average of 90% of patients with chronic gastritis. This form of nonerosive gastritis is the result of infection with Helicobacter pylori bacterium, a microorganism whose outer layer is resistant to the normal effects of stomach acid in breaking down bacteria.
• Erosive and hemorrhagic gastritis - After H. pylori, the second most common cause of chronic gastritis is use of nonsteroidal anti-inflammatory drugs. These commonly used pain killers, including aspirin, fenoprofen, ibuprofen and naproxen, among others, can lead to gastritis and peptic ulcers. Other forms of erosive gastritis are those due to alcohol and corrosive agents or due to trauma such as ingestion of foreign bodies.
• Acute stress gastritis- the most serious form of gastritis which usually occurs in critically ill patients, such as those in intensive care. Stress erosions may develop suddenly as a result of severe trauma or stress to the stomach lining.
• Atrophic gastritis -  is the result of chronic gastritis which is leading to atrophy, or decrease in size and wasting away, of the gastric lining. Gastric atrophy is the final stage of chronic gastritis and may be a precursor to gastric cancer.
• Superficial gastritis -  is a term often used to describe the initial stages of chronic gastritis.
• Uncommon specific forms of gastritis include granulomatous, eosiniphilic and lymphocytic gastritis.

Symptoms

• Nonerosive H. pylori gastritis - Symptoms of H. pylori gastritis include abdominal pain and reduced acid secretion in the stomach. However, the majority of patients with H. pylori infection suffer no symptoms, even though the infection may lead to ulcers and resulting symptoms. 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.
• Erosive and hemorrhagic gastritis - Patients with erosive gastritis may also show no symptoms. When symptoms do occur, they may include anorexia nervosa, gastric pain, nausea and vomiting.
• Other Forms of Gastritis - Less common forms of gastritis may result from a number of generalized diseases or from complications of chronic gastritis. Any number of mechanisms may cause various less common forms of gastritis and they may differ slightly in their symptoms and clinical signs. However, they all have in common inflammation of the gastric mucosa.

Treatment
Specific treatment will depend on the cause and type of gastritis.

• Medications:  These 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 constant infusion of a drug to stop bleeding.
• Surgery:  Sometimes surgery is recommended, but is weighed with the possibility of surgical complications or death. Once torrential bleeding occurs in acute stress gastritis, mortality is as high as greater than 60%.