Gastritis

Gastritis: Excerpt from Handbook of Diseases

An inflammation of the gastric mucosa, gastritis may be acute or chronic. Acute gastritis produces mucosal reddening, edema, hemorrhage, and erosion. Chronic gastritis is common among elderly people and those with pernicious anemia. It’s commonly pres-ent as chronic atrophic gastritis, in which all stomach mucosal layers are inflamed, with reduced numbers of chief and parietal cells.

Causes

Acute and chronic gastritis vary in causative factors.

Acute gastritis

Acute gastritis is commonly caused by infection, such as with Helicobacter pylori, or with other acute infecting organisms.

Chronic gastritis

Chronic atrophic gastritis may be Type A, resulting from autoimmune factors and found predominantly in the body of the stomach, or Type B, resulting from H. pylori and found predominantly in the antral part of the stomach.

Signs and symptoms

The patient with acute gastritis typically reports a rapid onset of symptoms, such as epigastric discomfort, indigestion, cramping, anorexia, nausea, vomiting, and hematemesis. The symptoms last from a few hours to a few days. A patient with chronic gastritis may complain of similar symptoms or mild epigastric pain.

Erosive gastritis is usually asymptomatic. If symptoms are present, they include nausea, vomiting, anorexia, and epigastric pain. The patient with erosive gastritis probably will develop upper GI bleeding with coffee-ground emesis or melena.

Diagnosis

The following tests are usually included to diagnose gastritis:

❑ Fecal occult blood test can detect occult blood in vomitus and stools if the patient has gastric bleeding.

❑ Hemoglobin level and hematocrit are low if significant bleeding has occurred.

❑ Upper GI endoscopy with biopsy confirms the diagnosis when performed within 24 hours of bleeding. An upper GI series may also be performed to exclude serious lesions.

Clinical tip  Upper endoscopy is contraindicated after ingestion of a corrosive agent.

Treatment

H. pylori infection is treated with antibiotics (amoxicillin) if the patient is immunocompromised. Treatment is aimed at the sequelae, not the inflammation.

Histamine₂-receptor antagonists, such as cimetidine and ranitidine, may block gastric secretions. Antacids may also be used as buffers.

For critically ill patients, antacids administered every 4 hours when the pH of the stomach is less than 4.0, with or without histamine-receptor antagonists, may reduce the frequency of gastritis attacks. Some patients also require analgesics. Until healing occurs, oxygen needs, blood volume, and fluid and electrolyte balance must be monitored.

When gastritis causes massive bleeding, treatment includes blood replacement, nasogastric lavage, angiography with vasopressin infused in normal saline solution and, sometimes, surgery.

Vagotomy and pyloroplasty have achieved limited success when conservative treatments have failed. Rarely, partial or total gastrectomy may be required.

If pernicious anemia is the cause, vitamin B₁₂ may be administered parenterally.

Special considerations

❑ For vomiting, give antiemetics and I.V. fluids. Monitor fluid intake and output and electrolyte levels.

❑ Monitor the patient for recurrent symptoms as food is reintroduced; provide a bland diet.

❑ Offer smaller, more frequent meals to reduce irritating gastric secretions. Eliminate foods that cause gastric upset.

❑ Administer antacids and other prescribed medications.

❑ If pain or nausea interferes with the patient’s appetite, give analgesics or antiemetics 1 hour before meals.

❑ If the patient smokes, refer him to a smoking-cessation program.

❑ Urge the patient to seek immediate attention for recurring symptoms, such as hematemesis, nausea, and vomiting.

❑ Urge the patient to take prophylactic medications as prescribed.

❑ Advise the patient to take steroids with milk, food, or antacids to reduce gastric irritation.

❑ Instruct the patient to take antacids between meals and at bedtime and to avoid aspirin-containing compounds.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

More About Gastritis

• Back to disease: Gastritis: Introduction
• Next Book Extract About Gastritis: Vomiting (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

 » Next page: Vomiting (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

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