Gastritis

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:

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.