Gastritis is a general term for a group of conditions with one thing in common; inflammation of the lining of the stomach.  Some of its symptoms are nausea and vomiting and abdominal pain or burning sensation in the upper abdomen. We interviewed  Dr Uditha Dassanayake, Consultant Gastroenterologist and Hepatologist to discuss Gastritis.  

Q WHAT ARE THE SYMPTOMS  OF GASTRITIS? Gastritis is an inflammation of the inner lining of your stomach. It can be acute, which means it comes on suddenly, or chronic, which means it lasts for a long time. Symptoms of gastritis can include

• Nausea or vomiting
• Abdominal pain or burning sensation in the upper abdomen
• Feeling full after eating even a small amount
• Loss of appetite
• Belching
• Bloating
• Indigestion

Early diagnosis and treatment can help prevent complications, such as ulcers.

Q WHEN WOULD A PATIENT NEED URGENT TREATMENT FOR GASTRITIS? While gastritis itself is not usually an immediate emergency, there are some signs that indicate a need for urgent medical attention. These include:

1. Vomiting blood or blood in the stool: This could be a sign of internal bleeding, which requires immediate medical attention. Blood may appear bright red in vomit or make stool dark and tarry.

2. Severe abdominal pain: Especially if the pain is sudden and worsening, this could indicate a more serious condition like a perforated ulcer.

3. Dehydration: If persistent vomiting or inability to keep fluids down leads to dehydration, with symptoms like dizziness, weakness, or fainting, urgent medical attention is needed. If your gastritis symptoms are severe, prolonged (lasting more than a week), or not improving with lifestyle changes, it's also important to see a doctor to rule out any underlying causes.

Q WHAT ARE THE FACTORS THAT CAN INCREASE THE RISK OF GASTRITIS? Several factors can increase your risk of developing gastritis. Some key contributors can include

Infection Helicobacter pylori bacteria: This is the most common cause of chronic gastritis. This bacterium weakens the stomach’s protective lining, making it more susceptible to irritation and inflammation.

Substances

• Regular pain reliever/aspirin use: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin can irritate the stomach lining with prolonged use.
• Other medications: Certain medications like clopidogrel, steroids, and bisphosphonates can also precipitate gastritis.
• Alcohol: Excessive alcohol consumption can damage the stomach lining and increase gastritis risk.
• Smoking:  Smoking weakens the stomach’s defence mechanisms and irritates the lining, increasing gastritis risk.

Other factors

• Diet: Spicy or acidic foods can irritate the stomach, especially for some people. While not a direct cause, a diet lacking in fruits and vegetables may also contribute.
• Stress: Chronic stress can worsen gastritis symptoms and potentially contribute to its development.
• Medical conditions: Certain medical conditions like Crohn’s disease or autoimmune disorders like autoimmune gastritis can increase gastritis risk.
• Age: As you age, your stomach lining tends to thin, making it more vulnerable to damage and gastritis.

It’s important to note that some factors, like genetics, may also play a role in gastritis susceptibility.

Q WHAT ARE THE DIFFERENT TYPES OF GASTRITIS? Gastritis can be classified in a few different ways, depending on the cause, duration, and severity of inflammation. Here is a breakdown of the main types:

By Cause

• Helicobacter pylori gastritis: This is the most common type, caused by infection with the Helicobacter pylori (H. pylori) bacteria.
• Non-steroidal anti-inflammatory drug (NSAID)-induced gastritis: Caused by regular use of NSAID pain relievers like ibuprofen or aspirin.
• Reactive gastropathy (erosive gastritis): This type is caused by exposure to irritating substances like alcohol, cocaine, or reflux of bile from the intestines into the stomach.
• Autoimmune gastritis: In this less common type, the immune system mistakenly attacks healthy cells in the stomach lining, leading to inflammation.
• Eosinophilic gastritis: This rare form involves a buildup of white blood cells called eosinophils in the stomach wall, causing inflammation.

By Duration

• Acute gastritis: This comes on suddenly and usually lasts for a short period, often resolving within a few days with treatment.
• Chronic gastritis: This type develops gradually and persists for a long time, sometimes for years. Chronic gastritis can be further categorised based on the presence or absence of atrophy:
• Non-atrophic chronic gastritis: The stomach lining is inflamed but maintains its ability to produce digestive juices. H. pylori infection is a common cause.
• Atrophic chronic gastritis: Chronic inflammation leads to thinning and wasting away (atrophy) of the stomach lining, reducing its function. This type can develop from H. pylori or autoimmune gastritis. Understanding the type of gastritis helps determine the most appropriate course of treatment.

Q TREATMENT FOR THE ABOVE TYPES OF GASTRITIS? The treatment for gastritis depends on the underlying cause and severity of the condition. Here is a breakdown of different modalities of treatment a doctor might recommend:

Medication

• Antibiotics: If H. pylori bacteria are present, a combination of antibiotics is the mainstay of treatment to eradicate the infection and promote healing.
• Proton pump inhibitors (PPIs): These medications reduce stomach acid production, allowing the stomach lining to heal and relieving pain and discomfort. They are commonly used for both acute and chronic gastritis. yH-2 receptor antagonists: Similar to PPIs, these medications also reduce stomach acid production but are generally less potent. They may be used for mild gastritis or in combination with PPIs.
• Cytoprotective agents: These medications like sucralfate help coat and protect the stomach lining, promoting healing.

Lifestyle Modifications:

• Diet: Avoiding spicy, acidic, greasy, or irritating foods can significantly improve symptoms. Eating smaller, more frequent meals and following a bland diet for some time may be recommended during flare-ups.
• Limiting Alcohol and Caffeine: Both substances can irritate the stomach lining and worsen gastritis. Reducing or eliminating them can be beneficial.
• Smoking Cessation: Smoking weakens the stomach’s defences and irritates the lining. Quitting smoking is crucial for healing and preventing gastritis recurrence.
• Stress Management: Chronic stress can exacerbate gastritis symptoms. Techniques like relaxation therapy or exercise can help manage stress and improve overall well-being.

Remember, early diagnosis and treatment of gastritis are essential to prevent complications. If you experience any concerning symptoms, consult a healthcare professional for proper diagnosis and a personalised treatment plan.

Q ARE THERE ANY TESTS THAT CAN BE DONE TO DIAGNOSE IT AND IF SO WHAT ARE THEY? Various tests are available to diagnose gastritis and identify the underlying cause.

Blood Tests:

• Complete blood count (CBC): This checks for anaemia, which can be a complication of gastritis due to blood loss.
• H. pylori antibody test: This test detects antibodies your body produces in response to H. pylori infection. However, a positive result just indicates past or present infection, not necessarily active gastritis.

Stool Test

• H. pylori stool antigen test: This test directly detects H. pylori in stool samples, offering a more accurate assessment of current infection compared to the antibody test.

Breath Test

• Urea breath test: This is a highly accurate and non-invasive test for H. pylori. You ingest a substance containing urea, and if H. pylori is present, it breaks down the urea, releasing a gas that can be detected in your breath.

Imaging Tests

• Upper endoscopy (OGD): A thin, flexible tube with a camera is inserted through your mouth to directly visualize the lining of your oesophagus, stomach, and duodenum (first part of the small intestine). During an endoscopy, biopsies (small tissue samples) can also be taken from the stomach for microscopic examination to identify inflammation or other abnormalities. This is a more definitive test for diagnosing gastritis and can also help identify the cause. The choice of test depends  on several factors

Your symptoms:

The doctor will consider the severity and duration of your symptoms to determine the most appropriate test.

• Suspected cause: If H. pylori is suspected, a breath test or stool antigen test might be preferred.
• Overall health: Your age and any underlying medical conditions may influence the choice of test. It is important to discuss these tests with your doctor to understand which one is right for you.

Q WHAT ABOUT THE DIET AND FOOD TO AVOID FOR GASTRITIS PATIENTS?

Reduce irritants

• Spicy foods: Chili peppers, curries, and other spicy ingredients can irritate the stomach lining. Limit or avoid them during a gastritis flare-up.
• Acidic foods: Citrus fruits, tomatoes, and pickles can also be irritating. You may need to temporarily limit or avoid them.
• Coffee and alcohol: Both can irritate the stomach lining and worsen gastritis symptoms.

Eat smaller meals more frequently

• This can help to reduce the amount of work your stomach has to do at once. Aim for 5-6 small meals throughout the day.

Choose bland, easily digestible foods

These include:

• Rice: Rice is a good option as it is easy to digest.
• Yogurt: Yogurt is a good source of probiotics, which can help to promote gut health. Choose plain yogurt and add your own honey or fruit for flavour.
• Bananas: Bananas are bland and easy to digest. They are also a good source of potassium, which can be helpful if you are experiencing diarrhoea.
• Well-cooked vegetables: Vegetables are a good source of vitamins, minerals, and fibre. However, raw vegetables can be difficult to digest. Stick to well-cooked vegetables during a gastritis flare-up.

Stay hydrated

• Drinking plenty of fluids can help to flush out toxins and keep your stomach lining moist. Aim for 8 glasses of water per day.

Text Kshalini Nonis