Gastritis
Himali Meshram
MD Pediatrics, MUHS Fellowship in Pediatric Gastroenterology and Hepatology
Consultant Pediatric Gastroenterologist and Hepatologist, Apollo Clinic, Nagpur, India.

First Created: 09/07/2020  Last Updated: 09/07/2020

Definition

Gastritis is defined as inflammation of the mucosal protective lining of the stomach. It develops when the gastric lining becomes thin or damaged and it comes in contact with hydrochloric acid secreted by the stomach.1

Types

It could be acute or chronic. Acute gastritis involves sudden and severe inflammation of the stomach lining while chronic gastritis involves long term mucosal inflammation which can even last for years.1

Classification of Gastritis

The mucosal disorders of stomach can be classified based on endoscopic features into erosive and non-erosive as follows:2

  1. Erosive and/or hemorrhagic Gastritis

    Stress induced

    Traumatic

    NSAID induced

    Portal hypertensive gastropathy

    Corrosive

    Radiation induced

  2. Non erosive Gastritis

    Helicobacter pylori gastritis

    Allergic

    Eosinophilic gastritis

    Crohn’s gastritis

    Celiac gastritis

    Pernicious anemia

Risk factors

There are various risk factors that account for gastritis including Helicobacter pylori infection, use of NSAIDs, stress, smoking, spicy food, etc.1 H. pylori is one of the important risk factors for acute and chronic gastritis. Low socioeconomic status, poor environmental hygiene, and cooking habits, etc are various factors that determine the likelihood to acquire the H. pylori infection in the childhood.3 H. pylori has also been associated with peptic ulcer disease, gastric adenocarcinoma, and MALToma. The burden of H. pylori infection is highest in developing countries like India.4

Symptoms

  • The symptoms of acute gastritis include stomach pain, heartburn, nausea, vomiting, belching, bloated stomach.
  • Chronic gastritis have mild or no symptoms.

Diagnosis of H. pylori gastritis

  • Urea breath test5

    It is a non- invasive test and used to diagnose H. pylori infection. However it is difficult to perform in children. Patient is given a drink containing solution C14 containing urea. If H. pylori is present in the stomach, its urease enzyme will hydrolyse ammonia into water and CO2. The labelled carbon is thus exhaled in breath and measured.

  • Serological testing of IgG and IgA antibodies against H. pylori in blood, urine or saliva is not for clinical purposes.6
  • Upper-GI endoscopy6:
    • It is preferred in patients with suspected ulcer disease or gastritis.
    • It can detect presence of ulcers, bleeding.
    • Performing rapid urease test (RUT) on gastric mucosa for detecting H. pylori infection has sensitivity is of 75%–100%. RUT is easy, fast, inexpensive, and widely available, but limited with false positive results and affected with drugs.
  • Histopathological evaluation-

    It is considered gold standard to demonstrate H. pylori in the biopsy specimen. Histopathologically, H. pylori is seen as short, curved, or spiral bacilli resting on the epithelial surface or in the mucus layer of gastric mucosa.

  • Culture

    H. pylori is difficult to grow in culture medium, hence role of culture in diagnosis is limited.4

TREATMENT

If it is noticed that certain food items or stress, make the symptoms worse. Changing diet, lifestyle changes, and reducing stress can be helpful. NSAIDs and other drugs related ulcers are treated by stopping the causative medications and administering drugs that promote healing of the stomach lining.

Medical treatment

Gastritis is treated with acid-lowering drugs like-

  • Proton pump inhibitors (PPIs) -omeprazole or pantoprazole.
  • H2 blockers - ranitidine or famotidine.
  • Antacids like aluminium hydroxide or magnesium hydroxide neutralize the acid in stomach.

Recommended therapies for H. pylori infection:

6

  1. Triple therapy regimen

    Proton pump inhibitor (PPI) (1-2 mg/kg/day) for 14 days,

    Ampicillin (50 mg/kg/day) for 14 days,

    Clarithromycin (20 mg/kg/day), or metronidazole (20 mg/kg/day) for 14 days.

  2. Quadruple therapy:
    Proton pump inhibitor (PPI) (1-2 mg/kg/day) for 10-14 days,

    bismuth subsalicylate (8 mg/kg/day) for 10-14 days,

    Ampicillin (50 mg/kg/day) for 10-14 days, and

    Metronidazole (20 mg/kg/day) for 10-14 days

  3. Sequential therapy:
    PPI (1-2 mg/kg/day), Ampicillin (50 mg/kg/day) for 5 days,

    then PPI (1-2 mg/kg/day), Clarithromycin (20 mg/kg/day), and metronidazole (20 mg/kg/day) for 5 days.

Complications of H. pylori infection

  • The major complications include gastritis, peptic ulcer disease (duodenal and gastric).
  • 5

  • Atrophic gastritis with or without metaplasia have also been described in children.
  • Gastric adenocarcinoma are rare.
  • H. pylori has been associated with growth retardation and anemia.


1. A Descriptive Study on Lifestyle Factors Influencing Gastritis among University Students of UniKL RCMP in Malaysia. Firdous J, Muhamad N, Latif NA, Syazwani D, Hidayah N, et al. Indian Journal Of Natural Sciences. 2016;6:35.
2. Gastritis and Gastropathy of Childhood. Dohil R, Hassall E, Jevon G, Dimmick J. J Pediatr Gastroenterol Nutr. 1999 Oct;29(4):378-94.
3. Chronic gastritis. Sipponen P1, Maaroos HI. Scand J Gastroenterol. 2015 Jun;50(6):657-67.
4. Helicobacter pylori Associated Gastritis in Northern Maharashtra, India: A Histopathological Study of Gastric Mucosal Biopsies. Mujawar P, Nikumbh DB, Suryawanshi KH3, Pagare PS3, Surana A J Clin Diagn Res. 2015 Jun;9(6):EC04-6.
5. Helicobacter pylori infection: detection, investigation, and management. Czinn SJ. J Pediatr. 2005 Mar;146(3 Suppl):S21-6.
6. https://www.hindawi.com/journals/ulcers/2012/896509/


Gastritis Gastritis 09/07/2020
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