Gastritis, all you need to know

What does Gastritis mean?

The Gastritis meaning come from the Greek, is the combination of two words, “Gaster” = belly or stomach and “Itis” = inflammation, and all together means belly or stomach inflammation [1].

What is Gastritis?

The gastritis is a stomach illness, that is defined as a chronic or acute inflammation of the gastric mucosa which is the membrane layer of the stomach that contains the glands and the gastric pits [2].

What are the causes of Gastritis?

The Gastritis causes are several, between the most common we have:

• Bad eating habits, eat too much fast food, fried food, excess consume of carbohydrate etc., all the junk food produce a pH imbalance that increase the gastric acids and destroy the mucosa membrane that protect the stomach against the gastric acid and this acid reach the gastrointestinal muscle wall generating gastritis ulcer.
• The stress is other cause of gastritis; the stress produces a nervous tension that could generate a dysregulation in the mechanisms that regulate de gastric acids (pH), and the altered pH can disrupt homeostatic digestion, resulting in dysregulation of gastric acids [3].
• Medicaments abuse and alcohol, taking medications excessively, such as, acetylsalicylic acid (aspirin), ibuprofen or naproxen and other similar drugs and alcohol consumption are dangerous due to reduce the regulation of the pH and destroy the mucous membrane that protect the stomach from the gastric acids, and produce the gastric ulcer [4].
• Helicobacter pylori infection It is estimated that more than two thirds of the world´s population is infected by this bacterium, some patients have an asymptomatic infection, this bacteria produce gastritis due to penetrates the mucous layer of the stomach and adheres to the surface of the gastric epithelial mucous layer, produces ammonia from urea, to neutralize gastric acid, then migrates to the gastrointestinal muscle wall, Ammonia is responsible for the destruction of the mucosa, allowing the acid to penetrate the gastrointestinal muscle wall, generating inflammation [5].
• Autoimmune gastritis is other cause of gastritis, it is a chronic inflammatory disease with destruction of parietal cells of the corpus and fundus of the stomach [6]. The loss of parietal cells reduces secretion of gastric acid which is also required for absorption of iron and vitamin B12, so this lack of vitamins absorption produce anemia, for this reason many of the people that has been diagnosed as anemic should therefore be evaluated for the presence of autoimmune gastritis.
• Celiac disease, is a disease that attacks the intestine and can damage any organ, present in 1% of the world population, it is produced by intolerance to gluten, which can generate an autoimmune reaction in the body where auto antibodies are created that attack the same organs of the body affecting the intestinal mucosa that protects the walls of the stomach from gastric acid [7].

What are the Symptoms of Gastritis?

Depending of the Gastritis cause, it could present different symptoms, such as:

• Vomiting with blood clots similar to coffee ground.
• Vomiting with fresh, undigested blood, usually profuse.
• Nausea.
• Abdominal pain or Stomach upset.
• Dizziness when standing up.
• Abdominal inflammation.
• Vague discomfort in the upper abdomen during or after eating heaviness, a feeling of fullness, or heartburn.
• Burning or gnawing feeling in the stomach between meals or at night.
• Hiccups and Belching.
• Loss of appetite.

What are the types of gastritis?

The main types of gastritis are Chronic Atrophic, Erosive, Eosinophilic and Phlegmonous Gastritis:

Chronic Atrophic Gastritis:

It is characterized by stomach lining inflammation for a long time, it can cause the exposure of the blood vessels [2], a decrease in the number of glands and finally intestinal metaplasty occurs, which is a change in the appearance of the mature gastric cells to adapt and treat to survive a hostile environment. Intestinal metaplasia is believed to be an attempt by the stomach to repair the chronic infection and inflammation that has generated a previous chronic gastritis, most often by Helicobacter pylori bacteria. Intestinal metaplasia is a precursor lesion for gastric cancer.

Erosive Gastritis:

The Erosive gastritis is featured by multiple and superficial erosions in the stomach mucosa, due to the abuse of non-steroidal anti-inflammatory drugs consumption [2] and could affect the stomach by gastrointestinal bleeding sometimes can evolve to peptic ulcer.

Eosinophilic Gastritis:

Eosinophilic gastritis is one that presents inflammation due to concentration of eosinophils in the layers of the stomach wall [15], Eosinophils are one of the different cell types that are part of the immune system and participate in the immune response to infections, but they can be involved in a variety of ways. of pathologies, such as inflammatory processes or allergies.

Phlegmonous Gastritis:

The Phlegmonous Gastritis is an infection of the deeper layers of the stomach known as submucosa and muscularis. This purulent bacterial infection may lead to gangrene.

This infection could be caused by vary bacteria [14] such as H. pylori, streptococci, staphylococci, Proteus species, Clostridium species, and Escherichia coli. Phlegmonous gastritis usually occurs in individuals who are debilitated. This kind of gastritis occur in people with other diseases, including stomach cancer, AIDS, malnutrition, or other malignancies. It is associated with a recent large intake of alcohol.

How to diagnose Gastritis?

There are many ways to diagnose gastritis, between the most known we have:

Diagnostic of stress, Medicaments-alcohol abuse and Bad eating habits Gastritis

To diagnose whether gastritis is caused by stress, alcohol or drug abuse and poor eating habits, a history must first be carried out on the patient, the interview is important to determine the rhythm of life of the affected person, in this way patterns can be analyzed that can lead to more accurate analysis in conjunction with clinical analysis techniques.

The stress, Medicaments-alcohol abuse and Bad eating habits can be the key trigger to find the main source of gastritis.

The main diagnostic method for gastritis is upper gastroscopy by identification of subjects with a normal gastric mucosa, depending on what is observed, a more in-depth evaluation can be progressed to detect the primary origins of gastritis.

Diagnostic of Helicobacter Pylori Gastritis

There are few methods to diagnose Helicobacter Pylori Gastritis infection based either on the direct or indirect detection of the bacteria.

The current direct methods are performed on biopsy specimens obtained at endoscopy. Histological examination must always be performed because in addition to H. pylori detection it allows observation of the lesions present.

PCR has been more recently introduced and exhibits a good sensitivity and specificity. Rapid tests, such as the rapid urease test and examination of a Gram stained biopsy smear, are convenient and cheap but of lower sensitivity. Indirect methods are based either on the serological IgG response or the labelled urea breath test. Both are sensitive [13]. The breath test is especially adapted to post-treatment control while serology is of interest for screening patients and epidemiological studies.

Diagnosis of Celiac Gastritis

Diagnosis of Celiac gastritis is based on serologic, molecular, and bioptic testing.

Biopsy must still be considered the gold standard for Celiac gastritis diagnosis. HLA-DQ genotyping [10][11] can be used to screen asymptomatic children and in cases of histology/serology disagreement.

The IgA anti-transglutaminase test is considered highly important, as it shows high sensitivity and specificity and its levels correlate to the degree of intestinal damage.

The IgA anti-transglutaminase test [12] measures the level of IgA, one of the body´s main antibodies, in the blood. Antibodies are proteins made by the immune system to fight attacks by bacteria, viruses, and toxins.

Diagnosis of autoimmune gastritis

Laboratory diagnosis of autoimmune gastritis rests on serum biomarkers of antibody to parietal cell H/K ATPase and intrinsic factor and corpus atrophy on serum biomarkers of gastrin and pepsinogen levels. Subjects with asymptomatic parietal cell antibody should be regularly assessed for serum biomarkers for progression to corpus atrophy, development of iron and B12 deficiency anemia and for associated autoimmune thyroiditis and type 1 diabetes mellitus [9].

What are the treatments for gastritis?

The Gastritis treatment always will be issued depending of the gastritis diagnostic, but the Gastritis treatment usually include:

Use of Proton Pump Inhibitors (PPI) such as omeprazole, and lansoprazole, that are irreversible inhibitors of Gastric hydrogen-potassium ATPase which also called H + / K + ATPase, is a transporter protein whose purpose is the acidification of the stomach [8].

H2 blockers, which are blockers of the actions of histamine at the level of the receptors on the parietal cells in the stomach, leading to a decrease in the production of acid from the gastric juice [16]. These function to inhibit the histamine-mediated stimulation of parietal cells, thus resulting in decreased phosphorylation and activation of H/K ATPase via protein kinase A.

For this, it is imperative for early administration of acid secretion inhibitors in the form of PPIs and H2 blockers to critically ill patients to prevent stress-induced gastritis. Since the etiology of gastric stress comes from angiotensin, studies are being conducted on how to reduce the effects of angiotensin on the gastric mucosa [3].

Currently to treat the Helicobacter pylori Gastritis, exist a therapy called triple therapy [5] and consisting of a proton pump inhibitor (PPI) (omeprazole, lansoprazole, pantoprazole, rabeprazole and others), plus two antibiotics: amoxicillin and clarithromycin is the treatment of choice, when resistance to clarithromycin by Helicobacter they do not exceed 20%. In case of allergy to penicillin, amoxicillin can be substituted for metronidazole. Eradication is achieved in 80-84% of cases.

Gastritis, Frequently asked questions (FAQ)

Are Gastritis and acid reflux the same thing?

No, acid reflux is the flow of stomach acid back into the tube that connects the throat to the stomach and creates a burning sensation in the chest (heartburn) and Gastritis is an inflammation of the gastric mucosa which is the membrane layer of the stomach.

Are Gastritis and gastroenteritis the same thing?

No, Gastroenteritis is an inflammation (“itis”) that joins the stomach (“gastro”) and small intestine (“entero”), the three together make up the word gastroenteritis in Greek and is produced by the action of bacterial agents [17] and gastritis It is the inflammation only of the gastric mucosa of the stomach.

Are Gastritis and gallstones related?

No, Gallstones are pieces of hard, solid matter that form over time in the gallbladder. Patients with gallstones are often affected by alimentary disorders contributing to the onset of gallstones disease [18] and the alimentary disorders can cause gastritis but it does not mean that they have a direct relationship.

Are Gastritis and Irritable bowel syndrome (IBS) related?

Yes, there studies that reveal the relationships between IBS and Chronic Gastritis (CG) [19]. IBS is a cascade of many physiologic events that is initiated by infection, inflammation, and psychological disturbances like many stresses, and this eventually terminates with gut dysfunction. Gastric acid is probably not involved in the etiology of IBS, but psychological factors also seem to be important in CG.

Are gastritis symptoms constant?

No, the symptoms could be intermittent depending of many factors, the origin and type or gastritis, for example the Celiac disease gastritis increase the intensity just when you consume gluten.

Are Gastritis and colitis the same?

No, the colitis is Colitis is a colon inflammation (“col” plus “itis”) and the gastritis is an inflammation of the stomach gastric mucosa.

Is Gastritis dangerous?

Yes, If the gastritis is not treated could generate a gastric ulcer that will cause an internal bleeding and stomach perforation and cause the dead.

Can Gastritis cause back pain?

No, the gastritis just could cause pain around the stomach.

Can Gastritis be cured?

Yes, if the gastritis is identified and well treat just on time, it can be cured.

Can Gastritis kill you?

Yes, If the gastritis is not treated on time can cause gastric ulcer and an internal bleeding then stomach perforation finally could cause the dead.

Can Gastritis cause constipation?

No, there are not evidence that gastritis cause constipation knowing that it is an alteration of the intestine that consists of an excessive retention of water in the large intestine and the consequent hardening of the stool, which makes it very difficult to expel it.

Can gastritis cause shortness of breath?

Yes, some rare cases can present shortness of breath, eventually attributed to severe autoimmune haemolysis in the context of atrophic gastritis and multiple type-1 gastric neuroendocrine tumours [20].

Can gastritis cause headaches?

Yes, some Symptoms of Gastritis can cause headaches such as vomiting, nauseas etc.

Can gastritis cause bloating?

Yes, Gastritis produce stomach inflammation that could generate abdomen bloating.

Can gastritis cause nausea?

Yes, nausea is one of the gastritis Symptoms.

Will gastritis heal on its own?

No, gastritis needs to be treat but it can get worse and cause dead.

Will gastritis show on a cross-section (CT) scan?

Yes, an abdominal cross-section CT scan can detect signs of inflammation, infection, injury or disease of stomach. It is also used to look at blood vessels and lymph nodes in the abdomen, but the best way to diagnostic gastritis is doing an endoscopy.

Will gastritis cause weight loss?

Yes, gastritis reduces the capability to absorb some vitamins necessary for the body and generate anemia so then weight loss.

Will gastritis come back?

Yes, if the patient does not follow the treatment and let go back to the factors that caused the initial gastritis, it could come back.

Who can get gastritis?

As you see in this article the Humans been can gets gastritis, so the dogs and cats [21] too, gastric foreign bodies and dietary indiscretions are common causes of acute gastritis in dogs and cats, the Helicobacter pylori is an important cause of gastritis and ulceration in humans but not the same for dogs and cats.

Which therapy is the best to treat Dogs and Cats gastritis?

The best therapy for animals with gastritis or gastric ulceration is removal of the causing agent, if possible, and try to improve the mucosal injury [21].