What is gastritis?

What causes it?

Some of the most common causes of gastritis include:

• Infection with Heliobacter pylori. This is a bacterium or bug that lives in the stomach. It is a known cause of peptic ulcer disease and gastric cancer (stomach cancer). The infection is usually acquired in childhood. Most infected people are asymptomatic (have no symptoms) and it is not known why some people with H pylori develop gastritis/peptic ulcers and others do not.
• Irritants. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac and Aspirin can damage the stomach lining and cause gastritis. Other irritants that are known to damage the lining of the stomach, although to a lesser extent than NSAIDs include:
• Eating spicy foods;
• Drinking alcohol and smoking. Both can make the condition worse by increasing the production of acid from the stomach;
• Pregnancy may exacerbate gastritis;
• Stress. (The role of stress in gastritis remains controversial.)


I have regular stomach ache - could this be gastritis?

Some people with gastritis experience no symptoms at all and the condition is only picked up coincidentally during a routine gastroscopy (a test that involves passing a tiny camera down the throat to look at the stomach). However, most people with gastritis will experience pain in the upper abdomen, which is often described as a gnawing pain. They also describe feeling a burning sensation in the chest. This may sometimes be confused with chest pain (angina). However, while chest pain usually occurs on exertion and is relieved by resting, the pain associated with gastritis is usually not related to exertion. Other symptoms of gastritis may include:
• Saliva may fill up into the mouth (waterbrash);
• Acid/bitter taste in the mouth;
• There may be associated nausea and vomiting.

How is gastritis diagnosed?

Your doctor will usually make a preliminary diagnosis based on your history. A physical examination may also reveal some tenderness in the upper abdomen. Further tests including a gastroscopy and CLO test. A Gastroscopy involves passing a tiny camera down the throat to look for inflammation of the oesophagus (gullet) and stomach. A sample of tissue may be taken (biopsy) and sent to the laboratory for analysis. You may be sedated for this procedure. The CLO test may also be done at the time of the gastroscopy to check for the presence of H Pylori.
A breath test may also be done to check for the presence of H Pylori and to confirm the diagnosis. This involves blowing into a bag, taking a drink and then after a period of time blowing into a bag again. Following treatment, a repeat breath test may be done to ensure eradication of the H Pylori.
Occasionally a blood count may be taken to check for anaemia.


What are the treatment options?

Gastritis can be easily treated. The type of treatment you receive depends on whether your gastritis is caused by H Pylori infection or irritants and lifestyle factors. Surgery is not needed in either case.

If your gastritis is caused by poor lifestyle choices, making a few changes will go a long way to relieving your symptoms.
• If you smoke - stop;
• Reduce your intake of alcohol or cut it out altogether;
• Avoid fatty foods and caffeine.

If the source of your gastritis is infection with H Pylori, you will need to take antibiotic drugs to eradicate the infection. The type of drug therapy most commonly prescribed to eradicate H Pylori infection is Triple Therapy. This usually comprises two antibiotics and a proton pump inhibitor (see explanation below). Side effects of the antibiotics include diarrhoea, decreased taste sensation and allergic reactions. If an antibiotic called metronidazole is prescribed alcohol should be avoided as it can cause flushing. Treatment may be prescribed for a week initially. Once the H Pylori is eradicated subsequent re-infection is rare.
Whatever the cause of your gastritis, your doctor may also prescribe some acid-reducing drugs to help reduce the stomach pain and burning sensation. These include:
• Proton pump inhibitors e.g. omeprazole, lansoprazole. These drugs block an enzyme involved in the production of acid from the stomach thus reducing its secretion. They produce good symptom relief and are generally well tolerated but can cause diarrhoea, rash and headache.
• Antacids such as aluminium hydroxide and calcium carbonate neutralise acid and are taken commonly for the relief of heartburn. They provide rapid relief of symptoms. An old treatment involved taking baking soda (sodium bicarbonate). However, taking too many antacids can cause side effects (diarrhoea, electrolyte abnormalities).
• Acid-secretion inhibiting drugs such as ranitidine, cimetidine. Side effects are few but Cimetidine may interact with some drugs including warfarin.
 
How can I prevent gastritis?

Gastritis caused by poor diet and lifestyle choices can be prevented by:
• Avoiding foods that cause the problem;

• Taking alcohol in moderation;

• Stopping smoking.

For pain relief, drugs like paracetamol or solpadeine will not affect the lining of the stomach. But do not exceed the daily limit of paracetamol as it can cause liver problems if taken in excess.