Gastritis

Gastritis Learning objectives: By the end of the lecture the student will be able to: • Define gastritis • List causes and risk factors of gastritis • Differentiate between types of gastritis • Discuss pathophysiology of acute and chronic gastritis • Enumerate types of chronic gastritis based on cause • List manifestations of gastritis • Mention diagnosis of gastritis • Explain treatment of gastritis • Clarify complications of gastritis • Discuss prevention of gastritis • List nursing management of gastritis • Apply nursing care plan for patient with gastritis 1 Gastritis Introduction: Gastritis is a general term for a group of conditions with one thing in common: Inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers or the regular use of certain pain relievers. Drinking too much alcohol also can contribute to gastritis. Gastritis may occur suddenly (acute gastritis) or appear slowly over time (chronic gastritis). In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis isn't serious and improves quickly with treatment. Definition Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. Causes and risk factors: Weaknesses or injury to the mucus-lined barrier that protects the stomach wall allows digestive juices to damage and inflame the stomach lining including: • Bacterial infection: Although infection with Helicobacter pylori is among the most common worldwide human infections, only some people with the infection develop gastritis or other upper gastrointestinal disorders. • Lifestyle choices, such as smoking and diet (high fat and salt). • Regular use of pain relievers: Pain relievers commonly referred to as non-steroidal antiinflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin IB, others) can cause both acute gastritis and chronic gastritis. • Age: Older adults have an increased risk of gastritis because the stomach lining tends to thin with age and because older adults are more likely to have H. pylori infection or autoimmune disorders than younger people are. • Excessive alcohol use: Alcohol can irritate and erode stomach lining, which makes stomach more vulnerable to digestive juices. • Stress: Severe stress due to major surgery, injury, burns or severe infections can cause acute gastritis. • Cancer treatment: Chemotherapy drugs or radiation treatment can increase risk of gastritis . • Diseases and conditions: Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn's disease, celiac disease, sarcoidosis and parasitic infections. 2 • Autoimmune disease: In some people, the body’s immune system attacks healthy cells in the stomach lining. • Bile reflux: Bile reflux occurs when bile flows back into the stomach instead of moving through the small intestine. Types: • Erosive gastritis (Acute): This means the inflammation wears away the stomach lining. Eventually, this can cause lesions or ulcers. It is usually an acute gastritis and is more serious than the non-erosive form. Gastrointestinal (GI) bleeding is more common with erosive gastritis. • Non-erosive gastritis (Chronic): This means the stomach lining does not wear away. Instead, the lining can degenerate, or atrophy. The lining can also undergo a process called metaplasia. Non-erosive gastritis is usually a form of chronic gastritis and is often asymptomatic. Pathophysiology: a- Acute gastritis: The decrease in the prostaglandin synthesis is thought to be the reason for the injury to the gastric mucosa. The gastric mucosa is safeguarded from the deleterious effects of the gastric acid by mechanisms promoted by the prostaglandins. In the majority of cases of H. pylori infection, the infection is not eliminated and there will be gradual accumulation of chronic inflammatory cells over the next 3 or 4 weeks. Following transmission, H. pylori penetrates the gastric mucosa and multiplies close to the surface epithelial cells. Following adhesion to epithelial cells, the bacteria releases lipopolysaccharides (endotoxin) and chemotactic mediators which penetrate the surface epithelial cells B- Chronic gastritis is characterized by the accumulation of lymphocytes and plasma cells in the lamina propria. Chronic active gastritis implies that ongoing active inflammation is causing damage to epithelial cells. The most common cause of chronic gastritis is chronic bacterial infection of the stomach by 3 Helicobacter pylori. H. pylori is adapted to live in the low pH environment of the gastric lumen, and infection is common and often persists throughout life unless it is eradicated by treatment with antibiotics (often a combination of three antibiotics is employed) H. pylori initiates a chronic immunoreaction that usually results in the formation of germinal centers in the gastric mucosa (antrum and fundus). While the bulk of organisms remain extracellular in the mucous layer adherent to gastric mucosa, the ongoing immunoreaction results in persistent acute and chronic inflammation with ongoing injury to the gastric epithelium. Over time, infection can result in metaplasia of the gastric mucosa to small intestinal type mucosa or loss of specialized gastric epithelium (atrophy). Chronic Helicobacter gastritis and the resulting oxygen free radicals and inflammatory mediators predispose to the development of adenocarcinoma that can arise in metaplastic gastric mucosa . Types of chronic gastritis based on cause: • Autoimmune gastritis (e.g., pernicious anemia and cancer) that specifically destroys parietal cells and can ultimately result in gastric atrophy with the loss of all acid-producing parietal cells. • Infectious gastritus: the most common type, is caused by H. pylori bacteria, and can cause stomach ulcers, intestinal ulcers, and cancer . • Chemical gastritis: is caused by chemical irritants like nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, or bile. And it can also cause stomach lining erosion and bleeding . • Other types of gastritis include giant hypertrophic gastritis, which can be related to protein deficiencies. There is also eosinophilic gastritis, which can happen alongside other allergic conditions like asthma or eczema. Manifestations: Many people with gastritis don’t have symptoms. People who do have symptoms often mistake them for indigestion. Signs of gastritis include : • Upper abdominal pain or discomfort. • Nausea and vomiting. • Loss of appetite. • Losing weight without meaning to. • Bloating. • Feeling extra full during or after a meal. • Indigestion • Heartburn • Stomach ulcers . 4