Acute gastritis

International Classification (ICD)	K29.-
Symptoms	epigastric pain, gastrointestinal haemorrhage, Fever, Pain, Nausea, frequent belching, Heartburn, Loss of appetite
Possible causes	Alcohol, Nicotine, stomachic stimulants, Painkiller, Stress, Runner's Stomach, Helicobacter pylori
disease.indicated_substances	Pantoprazole
disease.contra_indicated_substances	Acetylsalicylic acid (ASA), Ibuprofen

Basics

Gastritis, or inflammation of the gastric mucosa, is inflammation-related damage to the gastric mucosa(lat. tunica mucosa gastrica), whereby, depending on the variation, superficial to deeper changes can occur in the mucosal tissue. In principle, a distinction is made between acute and chronic gastritis, with the course of the disease being the decisive factor.

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The gastric mucosa is a protective layer that lines the inside of the stomach. Through it, the stomach wall is protected from the stomach acid and digestive juices. Injuries to the mucosa, also called erosions, can cause the juices of the stomach to destroy the cells of the stomach wall. The affected person usually feels pain and gastrointestinal discomfort when this happens. Gastritis can also go unnoticed for a long period of time.

Approximately 20% of the population suffers from acute gastritis during their lifetime, and the risk increases with age.

Causes

The triggers of acute gastritis are manifold. Harmful substances or other factors that cause an excess of gastric acid can be the causes. These include:

Excessive consumption of alcohol and/or nicotine.
Excessive, frequent consumption of stomach-irritating stimulants such as coffee or hot spices
Excessive intake of certain medications such as painkillers and anti-inflammatories
Mental and physical stress
Bacteria-induced food poisoning e.g. by staphylococci or salmonellae
Irritation of the gastric mucosa by foreign bodies such as a feeding tube
Acids or alkalis
After surgical interventions
Burns
"Runner's stomach": hyperacidity of the stomach caused by running, diet and hormones

In the context of bacteria-induced gastritis, bacterial metabolites are primarily responsible for destruction of the gastric mucosa. In these cases, gastritis may be contagious due to transmission of the causative bacteria. Attention must be paid to adequate toilet hygiene, as the bacteria are usually excreted in the stool.

Symptoms

The main symptoms of both acute and chronic gastritis are the same and differ only in their timing. The symptoms of acute gastritis occur rapidly, whereas in a chronic form they develop over a longer time frame. Inflammation of the gastric mucosa is characterized by a variety of symptoms, but in many cases it can also proceed without symptoms. Possible symptoms are:

pain in the upper abdomen (epigastric pain)
unpleasant feeling of fullness
bloated abdomen
nausea and vomiting
loss of appetite
frequent belching
flatulence
heartburn
bad breath
unpleasant taste in the mouth

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Complications

In the course of severe gastritis, blood may also be found in the vomit or stool. The potentially dangerous clinical picture must therefore always be clarified by a physician.

Diagnosis

Medical history
For stomach problems, the primary care physician should be consulted first. If necessary, the patient should be referred to a gastroenterologist. The suspected diagnosis of acute gastritis can already be made with the help of the anamnesis (questioning about the medical history and symptoms).
Physical examination
Subsequently, the abdominal region is examined. Initially, the exact location of the pain is determined. By palpating the abdomen, this can be determined more precisely and is also an important indication of other possible causative diseases. During palpation, including the liver and spleen, indurations can also be detected. In addition, the doctor listens to the bowel sounds with a stethoscope (auscultation). By tapping the abdomen, accumulations of air or fluids can be registered.
Endoscopy
To clearly detect acute gastritis, a gastroscopy (endoscopy of the stomach) can be performed. For this purpose, a tube with a camera is inserted into the stomach via the mouth and the mucous membrane is viewed. In acute gastritis, this shows typical inflammatory changes such as redness and swelling. In the course of a biopsy, tissue samples can also be taken with a small forceps. This often makes it possible to find the definite cause of the gastritis and to exclude more dangerous clinical pictures such as stomach cancer or stomach ulcers.

Therapy

Mild courses of acute gastritis heal spontaneously in most cases. The use of medications can promote healing. More severe courses must be investigated and treated with more specific methods.

Support spontaneous healing	There are some ways that healing can be supported. For example, medications taken, as well as over-the-counter remedies, should be checked to see if they damage the stomach lining and discussed with the primary care physician. As a first measure, all foods that irritate the gastric mucosa should be avoided during the period of acute gastritis and a consistent diet should be followed. Avoiding coffee, alcohol and nicotine can significantly improve the healing process.
Symptomatic treatment of accompanying symptoms	If nausea and vomiting occur in addition to stomach pain, so-called antiemetics (e.g., metoclopramide, domperidone) can be used to curb nausea.
Over-the-counter acid inhibitors	Acid inhibitors can neutralize stomach acid, relieving symptoms. So-called antacids (e.g., aluminum hydroxide, magnesium hydroxide, calcium carbonate) are mostly available over-the-counter at pharmacies.

H2 blockers and proton pump inhibitors	Acute gastritis can also be treated with histamine receptor blockers (H2 blockers) or proton pump inhibitors (e.g.: esomeprazole, pantoprazole). Both substance groups ensure that less acid is formed in the stomach. This leads to recovery and healing of the inflamed gastric mucosa. These drugs may only be taken after precise clarification by a doctor.

Forecast

Mild cases of acute gastritis usually heal spontaneously within a few days without drug therapy. More severe cases usually require drug therapy, but are generally also easily treatable.

Illustration of the stomach with gastritis

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Acute gastritis can also develop as a result of chronic gastritis that has existed for some time. A frequent trigger for this is colonization by the bacterium Helicobacter pylori. This can be treated after diagnosis with the help of antibiotics (eradication).

The symptoms of acute gastritis can also occur in the context of other diseases of the esophagus and stomach, such as gastroesophageal reflux disease, gastric and duodenal ulcers or tumors. Therefore, in the case of acute gastritis, medical clarification is always necessary.

Prevent

Prophylaxis is especially important in cases of acute gastritis that has already been experienced, in order to prevent a recurrence.

Ensure a healthy and balanced diet
This includes reducing the amount of fat in the diet and taking in enough fiber. Strong seasoning, citrus fruits, coffee, alcohol and nicotine should be avoided as much as possible. When taking meals, care should be taken to eat them slowly.
Avoid medications that damage the stomach
Medications that irritate the mucous membrane should be avoided. These include specifically anti-inflammatory and analgesic drugs, such as acetylsalicylic acid, ibuprofen or naproxen. If there is a medical indication for such therapy, concomitant anti-acid therapy should be considered.
Ensure sufficient relaxation and rest
Stress and strain affect the health of the stomach. Opportunities and times for relaxation and rest should be found. Exercise can also help with this.

In high-risk patients, recurrent gastritis illnesses and special pre-existing conditions, permanent prophylaxis using acid-inhibiting drugs may be useful.