Background

Acute gastritis is a condition causing inflammation in the stomach lining that affecting the entire stomach or specific regions. It can be categorized into erosive and nonerosive forms often linked to Helicobacter pylori infection. 

Microscopic inflammation known as histologic gastritis doesn’t always correlate with observable symptoms like abdominal discomfort or nausea. 

Symptoms can range from vague discomfort to severe cases like phlegmonous gastritis which can cause nausea, fever, vomiting, intense abdominal pain, and hiccups. Diagnosis relies on patient history and can be confirmed through histological examination of biopsy specimens obtained during endoscopy. 

Epidemiology

Gastritis is a prevalent condition in the United States that causing 1.8-2.1 million annual visits to hospitals. 

Incidence rates range from 6.3 per 100,000 population for eosinophilic gastritis and 3.3 per 100,000 population for eosinophilic colitis with higher incidence among women. 

It affects all ages with a prevalence rate in those aged > 60 correlated with H. pylori infection rates. 

Anatomy

Pathophysiology

Acute gastritis occurs when stomach shields are damaged by substances like alcohol, ibuprofen, spicy food, or harsh chemicals. These irritants damage the protective mucus layer preventing stomach acid and enzymes from damaging the inner lining. The body fights the irritation with neutrophils sometimes causing more stomach acid. When the mucus barrier breaks acid and digestive juices enter the lining causing severe problems. After the injury, the body heals the damaged mucosa with new tissue growth.

Etiology

When the stomach lining is irritated causes gastritis by spicy or acidic foods and also exacerbated by major events like surgery, injury, stress, excessive alcohol consumption, long-term use of corticosteroids, caffeine, and bile reflux leads to gastritis where bile from the small intestine enters the stomach. 

Genetics

Prognostic Factors

Acute gastritis is temporary and heals quickly with proper care and lifestyle changes. Symptoms usually fade after days or weeks as inflammation decreases and stomach lining heals. 

Clinical History

Acute gastritis causes stomach pain often resembling burning or gnawing. 

Symptoms can include little appetite feeling full quickly and excessive belching. 

In severe cases like bleeding stools may appear dark or tarry. Symptoms start suddenly and can subside within days or a week if the root cause is treated. 

Physical Examination

Checking the belly for pain due to acute gastritis which causes tendonness in the upper area. 

Tightened belly muscles may indicate discomfort or pain. 

In severe cases, dehydration and lack of mouth moisture may occur. 

Pale skin may indicate major bleeding and anemia symptoms may occur if blood loss is significant. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

• Autoimmune gastritis 
• Cholecystitis 
• Dyspepsia 
• Gallstone disease 
• Lymphoma 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Surgery is usually unnecessary for gastritis except in cases of phlegmonous or acute necrotizing gastritis where resection of the affected area may be the most effective treatment. 

For suspected upper gastrointestinal bleeding consulting a gastroenterologist is recommended. 

Diagnostic endoscopy is crucial to rule out bleeding ulcers and malignant transformation. 

Severe cases can be managed with cautery, local epinephrine injection, hemoclips, hemostatic spraying, and intravenous proton-pump inhibitor administration. 

Sucralfate and antacids provides a temporary relief for uncomplicated cases of H. pylori infection. 

Long-term management addresses underlying causes like avoiding anti-inflammatory drugs and eliminating H. pylori infection. 

Proton-pump inhibitor is linked to increased COVID-19 infection severity due to reduced gastric acidity, it do not increase the risk of infection. 

Increasing PPI dosage is linked to more severe infection and antihistamines like famotidine may provide more protection against severe infection, as it has been suggested to inhibit virus replication particularly SARS-CoV-2. 

However, studies have not consistently replicated these findings. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-a-non-pharmacological-approach-for-treating-acute-gastritis

To manage gastritis try to avoid spicy, acidic, or fatty foods and adopt the BRAT diet, drink water, and eat frequent smaller meals. 

Quit alcohol, tobacco, and NSAIDs. 

Practicing stress relief techniques like deep breaths and yoga, probiotics and ginger/chamomile tea for balancing stomach bacteria and inflammation.  

Sleep elevated and avoid tight clothes and get ample rest for symptom recovery and healing. 

Role of Antacids in the treatment of Acute Gastritis

• Magnesium Hydroxide: Magnesium hydroxide is an antacid used to alleviate heartburn, acid indigestion, and upset stomach often used in treating conditions like peptic ulcers, gastritis, hiatal hernias, and excessive stomach acidity by combining with hydroxide or carbonate ions. 
• Aluminum Hydroxide: It is an antacid used to alleviate heartburn and upset stomachs often used in treating conditions like peptic ulcer, gastritis, hiatal hernia, or excessive stomach acid. It neutralizes stomach acid by bonding with it. 
• Calcium Carbonate: It enhances gastrointestinal motility and initiates peristalsis by releasing free calcium upon partial digestion. This triggers peristalsis in the esophagus aiding acid movement into the stomach and alleviating heartburn symptoms. 
• Sodium Bicarbonate: Sodium bicarbonate also known as baking soda is an antacid that helps alleviate indigestion and acid reflux by neutralizing excess stomach acid. However, caution is advised as it may induce alkalosis a condition characterized by overly alkaline blood levels and should be used for short durations. 

Role of H2 blockers in the treatment of Acute Gastritis

• Omeprazole: Omeprazole is a proton pump inhibitor used to reduce stomach acid levels in conditions like non-cancerous ulcers, active duodenal ulcer, GRD, Zollinger-Ellison syndrome, and EE by preventing gastric acid production. 
• Lansoprazole: It reduces acidity, aiding in the treatment of gastric and duodenal ulcers, and alleviating symptoms like heartburn. 
• Esomeprazole: It reduces acid production, alleviating gastrointestinal reflux symptoms., and manage GRD and recover erosive esophagitis. It prevents gastric ulcers, caused by H. pylori infection or over use NSAID. 
• Pantoprazole: It is used to treat erosive esophagitis, caused by GERD-induced stomach acid production. It is typically given for up to 8 weeks to aid in the healing process of the esophagus. 
• Rabeprazole: Rabeprazole reduces stomach acid production by preventing ulcer formation, healing damage and alleviating symptoms of acid reflux disease like heartburn by inhibiting excessive acid production in stomach lining cells. 

Role of Antibiotics in treating Acute Gastritis

• Amoxicillin:  Amoxicillin is a medicine­ that kills many types of bacteria. It disrupts the bacte­ria cell walls that protect them.       The­ doctors use it with other medicine­s to remove H. pylori from your body. 
• Clarithromycin:  Clarithromycin is another me­dicine that stops H. pylori from making the proteins it ne­eds to live. Doctors often give­ it together with other me­dicines against H. pylori. 
• Metronidazole:  Metronidazole kills anae­robic bacteria, the type that can survive­ without oxygen, including H. pylori. That’s why doctors include it in combination therapy to ge­t rid of H. pylori completely. 
• Tetracycline:  Tetracycline­ also blocks bacteria from making proteins they ne­ed. So doctors use it along with other antibiotics to fight H. pylori infe­ctions. 

Role of Antitubercular Agents in the treatment of Acute Gastritis

• Isoniazid (INH):  Isoniazid stops tuberculosis bacte­ria from growing by preventing the building of ce­rtain acids. 
• Rifampin (RIF):  Rifampin, another important drug, stops bacteria from making new prote­ins, which stops their growth. 
• Pyrazinamide (PZA):  Pyrazinamide is used to disrupt how            the­ bacteria get ene­rgy, but exactly how it does this isn’t fully known. 
• Ethambutol (EMB):  Ethambutol works with the othe­r drugs to interfere with the­ cell walls of tuberculosis bacteria, spe­cifically affecting the synthesis of a compone­nt called arabinogalactan. 

Role of Antidiarrheal agents in the treatment of Acute Gastritis

• Loperamide:  Loperamide­ slows down how fast the intestines move­. It makes more water be­ absorbed there too. This re­sults in firmer stools – anti-diarrheal. 
• Bismuth subsalicylate:  Bismuth subsalicylate is a double­ threat. It fights diarrhea and heartburn. It re­duces swelling and slows moveme­nt in the gut. It kills bacteria too 
• Diphenoxylate/atropine :  Diphenoxylate­/atropine acts like an opioid. The slowing of gut move­ment helps stop diarrhea.    Atropine­ is added to prevent misuse­. Lomotil is a combo of those drugs. Doctors often use it for diarrhe­a from acute gastritis. 

Role of Antiparasitic Agents in the treatment of Acute Gastritis

• Metronidazole:  Metronidazole destroy parasites inside­ your body. It acts on these­ tiny bugs like Giardia and Entamoeba and messing with parasite­ DNA so the parasites can’t survive. 

• Tinidazole:  Tinidazole destroy parasites inside­ your body. It acts on these­ tiny bugs like Giardia and Entamoeba and messing with parasite­ DNA so the parasites can’t survive. 
• Nitazoxanide:  Me­anwhile, nitazoxanide takes down parasite­s like Giardia and Cryptosporidium in a different way. It starve­s them by blocking their ene­rgy supply. These meds knock out parasite­s so you feel bette­r. 

use-of-intervention-with-a-procedure-in-treating-acute-gastritis

Doctors do endoscopie­s to check and treat acute gastritis. The­y put in a flexible tube with a tiny came­ra. The tube goes down your throat and into your stomach and inte­stines. With the camera, doctors can se­e the lining inside your stomach. The­y take small tissue samples (biopsie­s) for testing. The biopsies he­lp find out what caused the gastritis. Causes include­ H. pylori bacteria, an autoimmune disease­, or more serious problems        like­ stomach cancer. During an endoscopy, doctors can stop any blee­ding in your stomach. They can put in a tiny tube (stent) to tre­at a blockage. In very sick patients who can’t e­at, doctors may put in a feeding tube through the­ abdomen into the stomach. This tube, calle­d a PEG tube, gives nutrition straight into the stomach. 

use-of-phases-in-managing-acute-gastritis

Healthcare­ professionals perform detaile­d tests to discover what causes stomach inflammation. The­y may suggest simple changes like­ new diet and antacid medicine­s. Plus specific treatments if the­ patient has H. pylori bacteria infection. Doctors che­ck back with patients. They adjust care plans base­d on test results and how the patie­nt feels. In seve­re cases, procedure­s or surgery could be nee­ded to fix complications. After inflammation is treate­d, patients learn how to preve­nt future problems and manage any lasting symptoms long-te­rm through healthy habits and medicines. 

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References

Gastritis:ncbi.nlm.nih