Gastritis
An inflammation of the gastric mucosa, gastritis may be acute or chronic. Acute gastritis, the most common stomach disorder, produces mucosal reddening, edema, hemorrhage, and erosion. Chronic gastritis is common among elderly patients and those with pernicious anemia. It’s often present as chronic atrophic gastritis, in which all stomach mucosal layers are inflamed, with reduced numbers of chief and parietal cells. However, acute or chronic gastritis can occur at any age.
Causes
Acute gastritis has numerous causes, including:
chronic ingestion of irritating foods, such as hot peppers (or an allergic reaction to them), or alcohol
drugs, such as aspirin and nonsteroidal anti-inflammatory agents (in large doses), cytotoxic agents, caffeine, corticosteroids, antimetabolites, phenylbutazone, and indomethacin
ingested poisons, especially ammonia, mercury, carbon tetrachloride, or corrosive substances
endotoxins released from infecting bacteria, such as staphylococci, Escherichia coli, or salmonella.
Acute gastritis may also develop in acute illnesses, especially when the patient has major trauma, burns, severe infection, or hepatic, renal, or respiratory failure. It may also occur following major surgery.
Chronic gastritis usually involves an underlying pathology that results in atrophy of the gastric mucosa. It’s associated with pernicious anemia (type A chronic gastritis) and infection with Helicobacter pylori (type B chronic gastritis). Individuals with type A chronic gastritis are at risk for developing gastric cancer.
Complications
Gastritis usually resolves when the causative agent is removed; however, persistent or untreated disease can lead to hemorrhage, shock, obstruction, perforation, peritonitis, and gastric cancer.
Assessment
The patient’s history may reveal one or more causative agents. After exposure to the offending substance, the patient with acute gastritis typically reports rapid onset of signs and symptoms, such as epigastric discomfort, indigestion, cramping, anorexia, nausea, hematemesis, and vomiting. The signs and symptoms may last from a few hours to a few days.
The patient with chronic gastritis may describe similar signs and symptoms. He may, however, experience only mild epigastric discomfort or relate vague complaints. For example, he may report an intolerance for spicy or fatty foods or have mild epigastric pain that’s relieved by eating. Patients with chronic atrophic gastritis are often asymptomatic.
On inspection, the patient may appear normal, or he may exhibit signs of distress, such as fatigue, grimacing, or restlessness, depending on the severity of symptoms. If gastric bleeding has occurred, the patient may appear pale, and his vital signs may reveal tachycardia and hypotension. Inspection and palpation may disclose abdominal distention, tenderness, and guarding. Auscultation may reveal increased bowel sounds.
Diagnostic tests
