Erosive Gastritis

 Erosive Gastritis

 Overview

Erosive gastritis is gastric mucosal erosion caused by damage to mucosal defenses. It is typically acute, manifesting with bleeding, but may be subacute or chronic with few or no symptoms. Diagnosis is by endoscopy. Treatment is supportive, with removal of the inciting cause and initiation of acid-suppressant therapy. Certain intensive care unit patients (eg, head trauma, burn, multisystem trauma, mechanically ventilated) benefit from prophylaxis with acid suppressants.

Gastritis is inflammation in the lining of your stomach. This lining (a soft tissue called mucosa) protects your stomach from the acids, enzymes and microorganisms that pass through it every day. Gastritis happens when your immune system detects a threat to this barrier. Your immune system triggers inflammation in the tissues to help fight infections and promote healing

Type of gastritis

You can have acute gastritis or chronic gastritis.

Acute gastritis is sudden and temporary. The conditions that cause it are also acute.

Chronic gastritis is a long-term condition, though you may not notice it all the time (or at all). It tends to develop gradually, as a result of another chronic condition.

Gastritis can also be erosive or nonerosive.

Erosive gastritis means the thing that’s causing your gastritis is actually eating away at your stomach lining, leaving wounds (ulcers). It’s often a chemical, like acid, bile, alcohol or drugs.

Nonerosive gastritis doesn’t leave erosive changes but may cause irritation, such as reddening of the stomach lining. A specific form of nonerosive gastritis, atrophic gastritis, can cause your stomach lining to react by thinning or wasting away (atrophy). This can cause digestive issues.

Gastritis may go by a more specific name, based on the cause. Some examples are:

Infectious gastritis.

Drug-induced gastritis.

Alcohol-induced gastritis.

Stress-induced gastritis.

Autoimmune gastritis.

Eosinophilic gastritis.

Symptoms

Gastritis doesn't always cause symptoms. When it does, the symptoms of gastritis may include:

Gnawing or burning ache or pain, called indigestion, in your upper belly. This feeling may become either worse or better after eating.

Nausea.

Vomiting.

A feeling of fullness in your upper abdomen after eating.

The most common gastritis symptom is upper abdominal upset or pain. The pain is often described as an uncomfortable burning or gnawing sensation.

Besides pain, other potential symptoms of gastritis include:4

Belching

Abdominal bloating

Loss of appetite

Nausea or vomiting

Feeling of fullness after eating only a small meal (early satiety)

Blood in your vomit or dark or tar-colored stools may be a sign of bleeding in the stomach, as gastritis can promote ulcers (sores within the lining of the stomach).5

Additional signs and symptoms of bleeding in the stomach (all of which stem from related iron deficiency anemia) include:6

Fatigue

Trouble breathing

Dizziness

Weakness

Pale skin

Fast heartbeat

Causes

There are multiple possible causes of gastritis. One of the most common causes is an infection with the bacterium H. pylori, which can result from poor handwashing habits and other causes.3

Other potential causes include:1

Drinking too much alcohol

Smoking

Extreme stress

Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Infection with another bacteria, a virus, or fungus

In addition, gastritis may develop after major surgery, traumatic injury, burns, radiation, or a severe illness. Certain diseases and even treatments can also cause gastritis, such as:3

Pernicious anemia (an autoimmune disease that limits your ability to absorb vitamin B12)

Chronic bile reflux, often following bariatric surgery

Chemotherapy treatment for cancer

Infections

Infections are among the most common causes of gastritis, especially acute gastritis. Bacterial infections and viral infections associated with the stomach flu can cause a short-term reaction that usually clears by itself. H. pylori infection is a common, chronic bacterial infection that can cause chronic gastritis. Less commonly, parasite infections and fungal infections can also cause acute or chronic gastritis.

Chemicals

Alcohol and certain drugs can cause either acute or chronic gastritis, depending on how much and how often you use them. They can cause chemical erosion of your stomach lining (erosive gastritis). Overuse of NSAIDs (nonsteroidal anti-inflammatory drugs), such as aspirin and ibuprofen, is one of the most common causes of acute gastritis. Some recreational drugs, like cocaine, may also cause it.

Autoimmune disease

Autoimmune diseases cause chronic inflammation. In autoimmune disease, your immune system mistakenly attacks your body’s own cells with inflammation. Chronic autoimmune gastritis can happen spontaneously. Or, more rarely, you may have gastritis as a side effect of another autoimmune disease.

Reduced blood supply

A major surgery, trauma or critical illness can cause acute gastritis. Severe physiological stress causes your body to withdraw blood supply from your digestive system to redirect it toward your more vital organs. This lowers your stomach lining’s defenses, making it more vulnerable to the chemicals inside.

Additional causes

Other causes of gastritis include:

Radiation therapy (mucositis).

Chemotherapy.

Bile reflux.

What are the possible complications of gastritis?

Most of the time, gastritis is temporary and not serious. But if gastritis goes on for a while, it can eventually begin to damage your stomach lining. This can lead to complications.

Erosive gastritis and ulcer complications

Erosive gastritis can proceed to peptic ulcer disease. Ulcers can cause gastrointestinal bleeding, leading to anemia. Frequent ulcers can also cause scarring. Scar tissue in your stomach can become a problem if it narrows or blocks the openings at the bottom (pylorus). This is called gastric outlet obstruction (GOO).

An ulcer that doesn’t heal may eventually wear a hole all the way through your stomach wall (gastrointestinal perforation). This can allow bacteria from your stomach to escape into your abdominal cavity (peritonitis). Peritonitis can lead to further complications, including septicemia and sepsis.

Nonerosive gastritis, atrophy and metaplasia

Nonerosive gastritis causes complications much more slowly. But after many years, it can cause your stomach mucosa to diminish (atrophy) and to lose some of its functionality. You may have trouble digesting and absorbing certain nutrients, such as iron, folic acid and vitamin B12 (pernicious anemia).

Rarely, long-term gastritis can cause the cells in your stomach lining to restructure themselves to look like a different sort of tissue altogether. This is called gastric intestinal metaplasia. Healthcare providers consider this cellular change precancerous, meaning it can raise your risk of developing stomach cancer.

Diagnosis and Tests

A healthcare provider will start by asking you about your symptoms and health history. They might suspect gastritis based on your answers, but they won’t know for sure if you have it without testing for it. They might begin with an imaging test, such as an upper GI series, a series of X-rays of your upper GI tract. This test can detect ulcers or erosion in your stomach lining, though not always gastritis itself.

The real proof of gastritis is microscopic, so a healthcare provider will need a tissue sample to confirm it. They can take a sample (biopsy) during an upper endoscopy exam. This exam goes inside your upper GI tract with a tiny camera on the end of a long catheter (endoscope). An endoscopist can take a biopsy through the endoscope. They’ll usually recognize gastritis visually even before the biopsy confirms it.

You might need additional tests to isolate the cause of gastritis or to check for complications. Your provider may order:

Blood tests.

Stool test.

H. pylori breath test.

Management and Treatment

Acute gastritis goes away after the acute cause of it does. If you have an infection, in most cases your immune system will clear it out shortly, and then the inflammation will go down. If you briefly overdosed on alcohol or pills, your stomach lining will soon repair itself. If blood flow to your stomach was temporarily reduced but is now restored, your stomach lining will begin the healing process.

Chronic gastritis doesn’t go away by itself, but treatment can help it go away. Chronic gastritis is linked to another chronic condition that you have. Specific treatments can cure some of these conditions. Other conditions aren’t curable, but long-term treatments can reduce the inflammation they cause. Chronic gastritis may have done deeper damage to your tissues, so they may take longer to heal.

You can treat your symptoms with over-the-counter (OTC) medications that soothe irritation and neutralize stomach acid, like proton pump inhibitors (PPIs) or Pepto Bismol®. These can bring temporary relief while your stomach is healing. You have to make sure that the cause of your gastritis has been eliminated, though. So, make sure to see a healthcare provider even if you’re self-medicating.

How do you cure gastritis permanently?

Curing chronic gastritis requires professional care. The treatment will depend on the cause.

It might mean:

Antibiotics and other medications to treat H. pylori.

Finding alternative medications for conditions you’ve been treating with NSAIDs.

Addiction treatment services for alcohol use disorder or cocaine addiction.

Targeted drugs for autoimmune diseases.

In rare cases, surgery to fix gastrointestinal (GI) bleeding, ischemia or bile reflux.

Prescription acid-blocking medications to promote healing.

Outlook 

Most cases of gastritis improve quickly with treatment. Medication relieves symptoms for most people. For some, recovery may also involve permanent lifestyle changes. You may need to change the way you manage other conditions and quit or reduce substance use to prevent gastritis from coming back. If you’ve discovered an underlying chronic condition, you may have a new long-term treatment plan for it.

Type of Doctor Department : gastroenterologist