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. Certain ICU patients (eg, ventilator-bound, head trauma, burn, multisystem trauma) benefit from prophylaxis with acid suppressants. Causes of erosive gastritis include NSAIDs, alcohol, stress, and less commonly radiation, viral infection (eg, cytomegalovirus), vascular injury, and direct trauma (eg, nasogastric tubes). Superficial erosions and punctate mucosal lesions occur. These may develop as soon as 12 h after the initial insult. Deep erosions, ulcers, and sometimes perforation may occur in severe or untreated cases. Lesions typically occur in the body, but the antrum may also be involved. Acute stress gastritis, a form of erosive gastritis, occurs in about 5% of critically ill patients. The incidence increases with duration of ICU stay and length of time the patient is not receiving enteral feeding. Pathogenesis likely involves hypoperfusion of the GI mucosa, resulting in impaired mucosal defenses. Patients with head injury or burns may also have increased secretion of acid. Symptoms and Signs Patients with mild erosive gastritis are often asymptomatic, although some complain of dyspepsia, nausea, or vomiting. Often, the first sign is hematemesis, melena, or blood in the nasogastric aspirate, usually within 2 to 5 days of the inciting event. Bleeding is usually mild to moderate, although it can be massive if deep ulceration is present, particularly in acute stress gastritis. Acute and chronic erosive gastritis are diagnosed endoscopically. Diagnosis Acute and chronic erosive gastritis are diagnosed endoscopically. Treatment For bleeding: Endoscopic hemostasis For acid suppression: A proton pump inhibitor or H 2 blocker In severe gastritis, bleeding is managed with IV fluids and blood transfusion as needed. Endoscopic hemostasis should be attempted, with surgery (total gastrectomy) a fallback procedure. Angiography is unlikely to stop severe gastric bleeding because of the many collateral vessels supplying the stomach. Acid suppression should be started if the patient is not already receiving it. For milder gastritis, removing the offending agent and using drugs to reduce gastric acidity (see Drug Treatment of Gastric Acidity) may be all that is required. Prevention Prophylaxis with acid-suppressive drugs can reduce the incidence of acute stress gastritis. However, it mainly benefits certain high-risk ICU patients, including those with severe burns, CNS trauma, coagulopathy, sepsis, shock, multiple trauma, mechanical ventilation for > 48 h, hepatic or renal failure, multiorgan dysfunction, and history of peptic ulcer or GI bleeding. Prophylaxis consists of IV H 2 blockers, proton pump inhibitors, or oral antacids to raise intragastric pH> 4.0. Repeated pH measurement and titration of therapy are not required. Early enteral feeding also can decrease the incidence of bleeding. Acid suppression is not recommended for patients simply taking NSAIDs unless they have previously had an ulcer. NONEROSIVE GASTRITIS Nonerosive gastritis refers to a variety of histologic abnormalities that are mainly the result of H. pyloriinfection. Most patients are asymptomatic. Diagnosis is by endoscopy. Treatment is eradication of H. pylori and sometimes acid suppression. Pathology Superficial gastritis: Lymphocytes and plasma cells mixed with neutrophils are the predominant infiltrating inflammatory cells. Inflammation is superficial and may involve the antrum, body, or both. It is usually not accompanied by atrophy or metaplasia. Prevalence increases with age.
Deep gastritis: Deep gastritis is more likely to be symptomatic (eg, vague dyspepsia). Mononuclear cells and neutrophils infiltrate the entire mucosa to the level of the muscularis, but exudate or crypt abscesses seldom result, as might be expected by such infiltration. Distribution may be patchy. Superficial gastritis may be present, as may partial gland atrophy and metaplasia.
Gastric atrophy: Atrophy of gastric glands may follow in gastritis, most often long-standing antral (sometimes referred to as type B) gastritis. Some patients with gastric atrophy have autoantibodies to parietal cells, usually in association with corpus (type A) gastritis and pernicious anemia.
Atrophy may occur without specific symptoms. Endoscopically, the mucosa may appear normal until atrophy is advanced, when submucosal vascularity may be visible. As atrophy becomes complete, secretion of acid and pepsin diminishes and intrinsic factor may be lost, resulting in vitamin B 12 malabsorption. Metaplasia: Two types of metaplasia are common in chronic nonerosive gastritis: mucous gland and intestinal.
Mucous gland metaplasia (pseudopyloric metaplasia) occurs in the setting of severe atrophy of the gastric glands, which are progressively replaced by mucous glands (antral mucosa), especially along the lesser curve. Gastric ulcers may be present (typically at the junction of antral and corpus mucosa), but whether they are the cause or consequence of these metaplastic changes is not clear. Intestinal metaplasia typically begins in the antrum in response to chronic mucosal injury and may extend to the body. Gastric mucosa cells change to resemble intestinal mucosawith goblet cells, endocrine (enterochromaffin or enterochromaffin-like) cells, and rudimentary villiand may even assume functional (absorptive) characteristics. Intestinal metaplasia is classified histologically as complete (most common) or incomplete. With complete metaplasia, gastric mucosa is completely transformed into small-bowel mucosa, both histologically and functionally, with the ability to absorb nutrients and secrete peptides. In incomplete metaplasia, the epithelium assumes a histologic appearance closer to that of the large intestine and frequently exhibits dysplasia. Intestinal metaplasia may lead to stomach cancer. Symptoms and Signs Most patients with H. pyloriassociated gastritis are asymptomatic, although some have mild dyspepsia or other vague symptoms. Often the condition is discovered during endoscopy performed for other purposes. Testing of asymptomatic patients is not indicated. Once gastritis is identified, testing for H. pylori is appropriate. Diagnosis Endoscopy Often, the condition is discovered during endoscopy done for other purposes. Testing of asymptomatic patients is not indicated. Once gastritis is identified, testing for H. pylori is appropriate. Treatment Eradication of H. pylori Sometimes acid-suppressive drugs Treatment of chronic nonerosive gastritis is H. pylori eradication (see Treatment). Treatment of asymptomatic patients is somewhat controversial given the high prevalence of H. pylori associatedsuperficial gastritis and the relatively low incidence of clinical sequelae (ie, peptic ulcer disease). However, H. pylori is a class J carcinogen; eradication removes the cancer risk. In H. pylorinegative patients, treatment is directed at symptoms using acid-suppressive drugs (eg, H 2 blockers, proton pump inhibitors) or antacids
http://www.merckmanuals.com/professional/gastrointestinal_disorders/gastritis_and_peptic_ ulcer_disease/gastritis.html ast full review/revision January 2007 by Sidney Cohen, MD Content last modified November 2013
Erosive Gastritis
There are a lot of different gastro-intestinal disorders that can affect your body. Erosive gastritis is one such disorder that can cause a lot of pain and a slow degeneration of the gastro intestinal tract. Regular use of pain killers and steroids can slowly erode the lining of the stomach and intestines, resulting in the formation of small ulcers. You will eventually start to feel extremely uncomfortable every time you eat anything. Gastritis is a condition in which the lining of the gastrointestinal organs becomes inflamed. However, in erosive gastritis the lining slowly wears away, revealing holes in the flesh of the organ. ADVERTISEMENT This is a chronic condition that develops slowly through the years. Due to its chronic nature, it is also known as chronic erosive gastritis. This is one of the main differences between nonerosive gastritis and the erosive variety. Acute erosive gastritis may occur due to acute E. coli infections or consumption of a large amount of steroids over a short period of time. Severe erosive gastritis may require immediate medical attention. However, it cannot be completely treated. With drugs and diet, the condition can be effectively managed, but there are brief periods when the gastritis may simply flare up and cause a lot of discomfort. Mild erosive gastritis, though not reversible can be managed to a large extent. The flare ups are brief, and the pain and discomfort is not too much. A gastritis diet usually excludes all kinds of foods that could cause bloating, discomfort and flatulence. Such a diet also excludes most spices and almost all kinds of fats. Depending on the severity of the condition, your doctor will advise you and starting a diet to manage your gastritis. Erosive gastritis diet may also be set up using the advice of a dietician. Erosive gastritis symptoms are very simple to identify. These symptoms are very much like those of gastritis in general and only a detailed medical checkup would help a doctor diagnose the exact condition. Since erosive gastritis causes are also similar to the causes of general gastritis, it makes the erosive gastritis diagnosis even more difficult. Erosive gastritis treatment usually includes medication and a diet. In severe cases, surgery may have to be performed to remove the diseased tissue. This surgery is performed to prevent an infection from spreading. Erosive Gastritis Symptoms, Causes, Treatment & Diagnosis
Symptoms Most of the erosive gastritis symptoms are very easy to identify, but they are also extremely unpleasant and uncomfortable. Some of the most common symptoms of this condition include: Bloating, flatulence, increased belching, indigestion, and a change in stools. You may experience pain once you consume food or even water. The patient may also experience a sudden loss of appetite and an eventual loss in weight. The weight loss is usually drastic, in which the patient may lose drastic amounts of weight in a very short period. If you experience acute erosive gastritis due to stress, you would experience nausea and vomiting. In a rare case, erosive gastritis may lead to bleeding in the stomach. The blood may appear in the stools, and some patients may even experience bloody vomits. Blood is rare in erosive gastritis, and those who experience this symptom may also experience other gastritis symptoms for at least a week before the bleeding begins. It is recommended that those who have persistent symptoms for more than a week should discuss their condition with a doctor as soon as possible. Causes There are a number of factors that cause erosive gastritis One of the main erosive gastritis causes are a damaged stomach lining. This could occur due to underlying medical conditions such as Crohn's disease, food allergies and intolerances, colic, persistent acidity, gastrointestinal reflux, and infections due to bacteria like E. coli. While all of these can cause erosive gastritis, the condition is more commonly caused due to excessive consumption of certain drugs such as steroids and non-steroidal anti- inflammatory drugs or NSAIDs. Genetic conditions, viral diseases and bacterial diseases may also cause damage to the stomach lining. Long-term use of over the counter medications, without consultation with a doctor can also cause this condition. Stress is often also associated with erosive gastritis. Though there is not much evidence to support this theory, many doctors feel that managing stress and improving overall quality of life may help you prevent erosive gastritis. Trauma to the stomach, which causes injury to the lining of the gastrointestinal organs, may decrease the blood circulation to the organs, and ultimately lead to a lack of nutrition to the tissues. Treatment Erosive gastritis treatment is usually based on the diagnosis given by the doctor. Most treatments are a combination of diet and medication. There are some small dietary and lifestyle changes that you can practice in order to manage your condition. Erosive gastritis remedies can also be used to prevent the condition from getting worse. Start off by evaluating your meals. Eat small meals throughout the day, but make sure you do not eat junk foods as that will just aggravate the condition. Consume foods that are easy to digest. Avoid consuming fibers, fats and spices in your food. Avoid consuming whole grains, cereals, non-citrus fruits, green vegetables and dairy products. You may also have to avoid acidic foods such as tomatoes, oranges, and pineapple. Avoid consuming caffeine and alcohol. Stub the butt if you are a smoker. Even second- hand smoking can aggravate the condition, so it is important to avoid second-hand smoke as well. Processed foods that have added flavorings, preservatives, and added colors can cause problems. In addition to this, avoid consuming processed meats like sausages, salami, and pepperoni. Try and avoid drinking fizzy drinks as those could irritate your stomach's lining. Stress-relieving exercises such as deep breathing and meditation can help you keep your stress levels low. In this manner, you can prevent acute gastritis or stress induced flare ups. There is no erosive gastritis cure, but with the right kind of lifestyle and food habits, you can attempt erosive gastritis prevention. However, before using any home remedies, it is important to consult the doctor. Diagnosis The process of erosive gastritis diagnosis begins with the evaluation of symptoms. The doctor will discuss the symptoms of the patient in detail. A physical exam is conducted, in which the doctor attempts to locate exactly where the patient feels pain in the abdomen. Since the symptoms of erosive gastritis are similar to those of general gastritis, the doctor may have to take some additional tests to confirm the diagnosis. A blood sample may be taken to confirm the presence of viruses or bacteria. The doctor may also take a stool sample to check for blood. Some doctors also perform a small biopsy of the stomach to look for degeneration of the stomach lining. This is usually done through an endoscopy performed at the doctor's office. Further testing may include an ultrasound to check the stomach lining and an X-ray of the stomach. Once the condition is diagnosed, the doctor will discuss a treatment plan in detail. The doctor may put you on a diet and may also prescribe a proton pump inhibitor. A course of antibiotics may be prescribed in case of bacterial infections. Erosive gastritis prognosis is a debilitating condition and treatment for the same usually lasts long.