In chronic gastritis, the mucous membrane of the stomach is inflamed over a long period (months or years). In contrast to acute gastritis, the symptoms usually occur gradually or do not appear at all. Common chronic gastritis symptoms include digestive problems, nausea, loss of appetite or stomach pain.
There are a number of different triggers on the basis of which the clinical picture is subdivided.
Infection with the Helicobacter pylori bacterium and the use of certain pain medications (NSAIDs) or alcohol are the most common causes of chronic gastritis. Other causes are stress. Autoimmune Reactions. Treatment depends on the underlying cause. [1] [2] [3]
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What are the causes of chronic gastritis?
The most important triggers of chronic gastritis are:
Infectious triggers:
Infection with bacteria of the Helicobacter pylori species (H. pylori). This cause is by far the most common. Sometimes referred to as type B gastritis.
Infection with other pathogens (other bacterial strains, viruses, fungi, parasites)
Non-infectious triggers:
Damage to the gastric mucosa caused by chemical irritation. Commonly triggered by substances such as alcohol, certain pain medications such as non-steroidal anti-inflammatory drugs (so called. NSAIDs) or bile entering the stomach. This group is also known as type C gastritis.
A malfunction of the immune system leading to an autoimmune reaction. This is also called type A gastritis and occurs quite rarely.
It is not yet known what causes the autoimmune reaction, but people with autoimmune chronic gastritis often have other autoimmune diseases such as z.B. an autoimmune thyroiditis, Addison's disease or type I diabetes.
In the course of certain systemic diseases (Crohn's disease, sarcoidosis, celiac disease, allergies and malignant cancers). [1] [2] [3] [4] [5]
This results in the most important risk factors:
The repeated use of painkillers such as aspirin and ibuprofen (so called. NSAIDs); the additional use of cortisone-containing drugs increases this effect.
Infection with the bacterium H. pylori type B gastritis)
Infection with the H.-pylori bacterium is usually acquired in childhood, although symptoms very often develop later in life. The incidence of H.-pylori infections have been decreasing in industrialized countries since the 1960s, probably due to better hygiene practices. [2] [3] [4] [6] [7] [8] [9]
What are the symptoms of chronic gastritis?
People affected by chronic gastritis often have no symptoms or only mild symptoms. When chronic gastritis symptoms do occur, they are often gradual and sometimes last for a long time. Possible symptoms include: [3] [10]
– pain in the upper abdomen, – pain during or immediately after eating, – digestive problems, – nausea, – vomiting, – loss of appetite, – early feeling of fullness, – weight loss, – belching, – heartburn, – bad taste in the mouth.
Depending on the exact trigger and thus type of chronic gastritis, certain symptoms of gastritis and courses are likely to vary. The most important examples are:
When infected with the Helicobacter pylori bacterium (type B gastritis) Often, no symptoms appear here at all at first. However, the above symptoms are possible. Symptoms often appear later in the course after complications of the infection have developed (see below). [3]
In the course of certain systemic diseases In so-called systemic diseases that affect numerous parts of the body, the symptoms caused by chronic gastritis can be very mild. Instead, other symptoms typical for the respective disease are often in the foreground. [3]
In autoimmune chronic gastritis (type A gastritis) Pain and discomfort such as bloating, loss of appetite, nausea or vomiting are possible, but rather rare and usually milder than in other types of gastritis.
The main consequence of type A gastritis is anemia caused by a deficiency of vitamin B12 and, sometimes, iron. This deficiency is the result of decreased absorption of vitamin B12 and iron through the gastric mucosa. The onset of the disease is gradual and progresses slowly. [10] [11] [12] [13]
Possible additional symptoms of type A gastritis that may result are:
– Feeling weak, – lightheaded, – dizzy, – tinnitus, – heart palpitations, – tongue pain, – diarrhea, – numbness, weakness, and tingling in your arms and legs, – irritability .
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Differences between chronic and acute gastritis
Acute gastritis is also an inflammation or irritation of the stomach lining, but it lasts for a shorter time than chronic gastritis. A person affected by chronic gastritis sometimes has little or no symptoms. If pain occurs, it is typically dull and long-lasting. Acute gastritis tends to have a more rapid onset, with pain often being more severe. In some cases, acute gastritis can turn into chronic gastritis. [14]
Differences between gastritis and gastroenteritis
Both acute and chronic gastritis directly affect the lining of the stomach and can cause nausea and vomiting. Gastroenteritis, on the other hand, affects the intestines as well as the stomach. Often also referred to as gastrointestinal virus. In addition to frequent symptoms such as nausea and vomiting, gastroenteritis is also likely to cause diarrhea, which is not a typical symptom of gastritis. [1] [15]
How is chronic gastritis diagnosed??
First, a doctor will take the affected person's medical history. This involves u.a. questions about taking medications such as aspirin and ibuprofen (sog. NSAIDs), to alcohol consumption and to stays in countries with low hygiene standards and therefore a high H.-pylori proliferation. The doctor will then perform a physical examination, paying particular attention to the abdomen. To reliably prove the presence of chronic gastritis, analysis of a tie sample of the gastric mucosa is crucial. In addition, blood sampling is needed to identify the underlying trigger as well as possible complications. [3] [16]
The following examination methods can be used: [17] [3] [10] [11]
Laboratory tests
– Blood tests for anemia (vitamin B12, iron, hemoglobin, red blood cells). – Blood tests to find antibodies that mistakenly trigger an immune response against cells in your own stomach. – Blood tests to evaluate liver and kidney function. Analysis of a stool sample for blood. The presence of the H.-pylori bacterium.-pylori bacterium. – A so-called urease breath test (also 13C-urea breath test) can also detect the presence of the H- pylori bacterium. The test is non-invasive, easy to perform and is often used in people under 60 years of age.
Endoscopy
– An endoscope is a type of long tube with a camera at the end of it. In this way, doctors can examine the gastric mucosa up close and take tie samples by passing the endoscope through the mouth and esophagus into the stomach. – This procedure is usually used for people over 60 years of age with clear indications of gastritis. – Upper gastrointestinal (GI) endoscopy is essential to confirm the diagnosis of gastritis. As a rule, several tie samples are taken at the same time. In many cases, the right conclusion about the underlying trigger of gastritis can already be made by examining the gastric mucosa with the endoscope. Analysis of tie samples is still required.
Biopsy
– With the help of the tie samples (biopsy), precise statements can be made about the localization of the gastritis in the stomach, the severity and any degeneration of individual cells (see complications). – Biopsy is also the standard method of determining whether the H.-pylori bacterium is the underlying cause of gastritis.
What is the treatment for chronic gastritis??
Treatment of chronic gastritis depends on the underlying cause. If the disease is complicated by repeated use of non-steroidal anti-inflammatory drugs (so-called. NSAIDs), such as aspirin or ibuprofen, or the excessive consumption of alcohol is caused, it is imperative that the individual stop taking these substances.
Physicians can help find a good alternative for pain medications or take the right measures for withdrawal symptoms, as well as provide the necessary support, e.g., a prescription.B. through self-help groups for alcoholics, to be arranged. [5]
Treatment of H.-pylori infection
H. pylori is a bacterium that can only be eliminated by the use of antibiotics. If the bacterium is successfully eradicated as a trigger, the gastritis usually disappears as well.
Initially, therefore, a combination of three drugs is used to treat the H.-pylori infection is used. This treatment includes a proton pump inhibitor (PPI) – a drug that reduces the amount of acid produced by the stomach – and two different antibiotics. This is necessary to prevent bacteria from developing resistance to a single antibiotic. The whole is called triple therapy or triple therapy. The duration of treatment is between 10 and 14 days.
Following a completed H.-pylori treatment, the success of the treatment still needs to be confirmed. This is done at least 4 weeks after the start of treatment. Eradication of the bacterium can be assessed by noninvasive methods such as the urea breath test or the stool antigen test. In most cases, triple therapy will successfully eliminate the infection. If additional treatment is required, physicians usually recommend a quadruple therapy. This involves a PPI. Three different antibiotics. [3] [10] [18]
Treatment of autoimmune chronic gastritis (type A gastritis)
Currently, there is no treatment that can cure type A gastritis. However, the vitamin B12 and iron deficiency that often results can be treated with supplements in the form of tablets, injections or infusions.
Even though type A gastritis cannot be eliminated by treatment, the risk of developing stomach cancer as a complication of the disease is still low to low. Nevertheless, physicians:inside may recommend endoscopy to detect early signs of stomach cancer. Treatment of stomach cancer is generally more effective the earlier the disease is detected and treated. [11] [12]
Diet and other measures for chronic gastritis
Diet does not play a role in the development of chronic gastritis, although it may be advisable to avoid eating hearty, spicy or acidic foods that irritate the stomach to relieve symptoms.
Eating smaller, more frequent meals instead of larger, heavier meals, weight reduction if overweight, and stress management can be useful adjuncts to, but not substitutes for, treatment of the trigger. Drugs that are freely available in pharmacies, such as z.B. Antacids, can relieve stomach and digestive discomfort, but will not solve the underlying problem and therefore should not be taken long term. If symptoms persist for more than a week or are severe, a doctor should be consulted.
What is the prognosis of chronic gastritis??
The prognosis of chronic gastritis is directly dependent on the underlying cause. The course of the disease also varies, sometimes greatly, from person to person.
A chronic gastritis, which is caused by the H.-pylori bacterium, may persist without any symptoms in some sufferers, while others suffer from severe and sometimes increasing symptoms. In addition, the prognosis also depends on whether complications develop as a result of the inflammation, such as.B. A gastric ulcer or stomach cancer. [3]
What are the possible complications of chronic gastritis?
Chronic gastritis can lead to complications in the absence of treatment or treatment that is not cause-specific. Because chronic gastritis is often asymptomatic, a complication can sometimes be the first sign that a person is affected by chronic gastritis.
Metaplasia of the gastric mucosa
Chronic gastritis can lead to Lead to change in the lining of the stomach, called intestinal metaplasia. This involves changes in the cells of the stomach lining. Become more like the cells in the intestine. This process is associated with an increased risk of cancer, although the risk remains low.
While the treatment of H.-pylori infection eliminates chronic gastritis, it remains unclear whether it is also effective in reversing intestinal metaplasia. Studies suggest that the removal of H. pylori can at least slow down intestinal metaplasia. [19]
If this process of transformation of the cells is very pronounced, it is also called atrophic gastritis. [17] [20] [21]
Gastric ulcers
A gastric ulcer is a wound of the stomach lining caused by an permanently increased gastric acid production Caused. Eight out of ten stomach ulcers are associated with a H.-pylori infection associated. Another cause is long-term use of NSAID pain relievers such as aspirin and ibuprofen. [2] [22] [23]
Symptoms of gastric ulcer include:
– Burning stomach pain, – Nausea and vomiting, – Bloating or rapid feeling of fullness, – Belching, – Heartburn, – Altered appetite, – Weight loss, – Difficulty breathing, – General feeling of weakness, – Vomiting blood, – Blood in stools or black stools.
Stomach polyps or cancer
Gastric polyps are outgrowths of the stomach lining.
They usually do not cause symptoms, but if they do, they can manifest as follows:
Most gastric polyps are benign, ie.h. Not carcinogenic, some can still develop into stomach cancer.
It is advisable to consult a physician should typical symptoms of gastritis be present (see above).
Good to know: The likelihood of developing stomach cancer due to gastritis is low. Regular screening is recommended for people who have been diagnosed with atrophic gastritis. [24] [25] [26] [27] [28] [29]
BMJ Best Practise. "Gastritis." – As of 10. July 2019
US National Library of Medicine. "Chronic gastritis." – Update: 10. July 2019
MedlinePlus. "Gastritis." – As of 10. July 2019
US National Library of Medicine. "How do NSAIDs cause ulcer disease?" – Status: 10. July 2019
Johns Hopkins Medicine. "Gastritis." – Update: 10. July 2019
National Institute of Diabetes and Digestive and Kidney Diseases. "Gastritis." – Stand: 10. July 2019
US National Library of Medicine. "Autoimmune gastritis." – Accessed 10. July 2019
Genetic and Rare Diseases Information Center. "Autoimmune atrophic gastritis." – Status: 10. July 2019
MedlinePlus. "Pernicious anemia." – Date: 10. July 2019
Medscape. "Acute gastritis." – Booth: 10. July 2019
BMJ Best Practise. "Viral gastroenteritis." – Status: 10. July 2019
Anvil. "Atrophic gastritis." – Stand: 10. July 2019
MedlinePlus. "Peptic Ulcer." – Status: 10. July 2019
National Institute of Diabetes and Digestive and Kidney Diseases. "Symptoms& Causes of Peptic Ulcers." – Status: 10.