Chronic Gastritis

What is Chronic Gastritis?

It is defined as the inflammation of the stomach lining which occurs slowly and persists for a long time. However, the term actually refers to a wide range of gastric tissues. It is primarily referred to as a chronic inflammation of the stomach mucosa. Most patients experience an asymptomatic form of the disorder. This condition sometimes develops into hemorrhage and ulcer formation.

Chronic Gastritis Types

On the basis of histology, the disorder can be categorized into three types:

Picture of Chronic Gastritis

Picture 1 – Chronic Gastritis

Superficial Gastritis

It occurs when inflammatory cells stay within the limits of gastric pits and upper lamina propria.

Atrophic Gastritis

It arises when inflammatory cells seep deeper into the lamina propria and glandular epithelium. Lymphoid follicles are also seen in this form. With the progression of the disease, the mucosa gets thinner and glandular elements are lost.

Gastric Atrophy

Patients suffering from this disease, experience loss of parietal and chief cells. Also the doctor will find that there is considerable thinning of mucosal thickness and presence of inflammatory cells in small number.

On the basis of the anatomy of the stomach and the presence of parietal cell antibodies, Chronic Gastritis can be divided into:

Type A

In this form, the fundus and the body of the stomach are connected. However, the antrum remains normal. Parietal cell antibodies are found in excess in patients. Pernicious anemia might also develop in this type.

Type B

In this type, the antrum is mainly involved. The inflammation however, is mainly found in the fundus and body; parietal cell antibodies are not present.

Chronic Gastritis Causes

The disorder is caused due to:

  • Pernicious anemia
  • Chronic bile reflux
  • Infection caused by the Helicobacter pylori bacteria
  • Degeneration of the lining of the stomach, due to old age
  • Extended periods of irritation, due to the usage of non-steroidal anti-inflammatory drugs

H pylori gastritis is a primary infection of the stomach and is known to be the main cause for the disorder. Other possible causes are either of the following factors or a combination of all of these:

  • Hiatus hernia
  • Vitamin deficiency
  • Excessive alcohol intake
  • Ulcers
  • Gastric juice abnormalities

The disorder is also related with parasitic infections, such as:

  • Schistosomiasis
  • Strongyloides species
  • Diphyllobothrium latum

Chronic Gastritis Symptoms

The disease gives rise to one or more of the following symptoms:

  • Indigestion
  • Nausea
  • Vomiting
  • Dark stools
  • Vomiting of blood or material that looks like grounded coffee
  • Appetite reduction
  • Pain in the upper abdominal section

Chronic Gastritis Diagnosis

The diagnosis of this condition is done by assessing complications of H pylori. In uncomplicated form of H Pylori, clinical proofs are few and not specific. Epigastric tenderness may be present. If gastric ulcers coexist, stool may have presence of guaiac which may lead to occult blood loss. Bad breath and abdominal pain may take place with bloating related with bacterial overgrowth syndrome. Other findings may include neurologic complications like autoimmune atrophic gastritis. The patient might be pale and might have a bit of icteric skin and eyes. The pulse will be rapid and the heart gets enlarged. Differential diagnosis includes diagnosis for presence of Crohn’s disease, gastroesophageal reflux disease and atrophic gastritis.

Other exams and tests are evaluation of complete blood count to detect anemia. Stool test to check for blood in them. Also, biopsies for gastritis and EGD or esophagogastroduodenoscopy are other tests which are a part of the diagnosis.

Chronic Gastritis Treatment

Treatment depends on the causes particularly which might disappear after some time. A peptic ulcer regimen treatment for aggravating factors can be helpful. The treatment will include salicylates, mild tranquilizers, caffeine-anticholinergic drugs and non-steroidal anti-inflammatory drugs.

Image of Chronic Gastritis

Picture 2 – Chronic Gastritis Image

H Pylori infection treatment

H pylori infection cannot be cured easily. Pharmacotherapy is recommended for it. Any bacterial infection should need antimicrobial agents. Antibiotics that have been effective in fighting bacteria are amoxicillin, tetracycline, clarithromycin, furazolidone, and metronidazole. The most prevalent treatment for this infection is triple therapies which are known as first line treatments. If triple therapies fail, then quadruple therapies are suggested as second line treatments. The best results are achieved by administering therapy for 10 to 14 days.

Triple therapy

Triple therapy consists of the following:

  • Clarithromycin 500g– should be taken orally two times a day.
  • Amoxicillin 1000g, Metronidazole 500 g- taken in oral form two times a day.
  • Lansoprazole 30 mg, omeprazole 20 mg, or ranitidine bismuth citrate 400g (take orally twice daily)

Quadruple Therapies

The quadruple therapies for this infection are as follows:

  • Bismuth subsalicylate 120 mg – It should be taken orally for 4 times every day.
  • Lansoprazole 30 mg or omeprazole 20 mg – It should be taken twice daily.
  • Metronidazole 500 mg – It should be taken via oral means, 3 times daily.
  • Tetracycline HCl 500 mg- It should be taken through oral route, 4 times daily.

H Pylori infections or chronic gastritis in children have been treated with Triple therapies and have found to be successful. Eradication of the disease has been found in 96% of the cases. However, children below 16 years of age should never take compounds that contain salicylate as it could lead to Reye Syndrome. Medications can be taken to minimize the level of stomach acidity. It will help in removing the symptoms.

The possible complications of this infection are increased risk of gastric cancer and loss of blood. Healthcare professionals should be contacted immediately when the gastritis do not heal after treatment. If a person is prone to Gastritis, he/she must not use aspirin.

References:

http://tcmdiscovery.com/Sino-western-Joint/info/20081204_1702.html

http://health.nytimes.com/health/guides/disease/gastritis-chronic/overview.html

http://en.wikipedia.org/wiki/Gastritis#Chronic

http://health.hpathy.com/gastritis-symptoms-treatment-cure.asp

http://emedicine.medscape.com/article/176156-differential

http://medical-dictionary.thefreedictionary.com/chronic+gastritis

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