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Gastritis & Dyspepsia

Gastritis & Dyspepsia

The Question

Upper Abdominal Pain

Causes of Gastritis

Chronic Forms of Gastritis

Management of Gastritis

Last Comment

 

The Question: "I am only fifteen years old and recently, just after eating I started getting pain in my stomach. Can I do something to make it go away? What can cause this pain? "... "


Dr. Keti:
July 18, 2003

Upper Abdominal Pain
Upper abdominal pain complaint, also know as dyspepsia, is a common patient’s complain. It includes a variety of clinical presentations and diagnoses, ranging from mild gastrointestinal infections to perforated duodenal(upper intestinal) ulcer and pancreatic cancer.
The Gastroesophageal Reflux Disease or GERD is another one of the most common conditions presenting to the primary care physician and is also associated with dyspepsia.

Inflammation of the stomach lining or gastritis is not a single disease and can be caused by drinking too much alcohol, prolonged use of no steroidal anti-inflammatory drugs (NSAIDs), or infection with bacteria such as Helicobacter pylori. Patients after major surgery, traumatic injury, burns, or severe infections are also prone to developing gastritis.
Diseases such as pernicious anemia, autoimmune disorders, or chronic bile reflux can also cause gastritis.

Experiencing some of the most common symptoms such as the abdominal upset or pain after having a meal is never pleasant. Other symptoms are belching, abdominal bloating, nausea(feeling sick), and vomiting or a feeling of fullness or burning in the upper abdomen. If there is blood in vomit or the stools appear black, it may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.

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Causes of Gastritis
Helicobacter pylori, a bacterium, causes one of the most common infections of the human gastric lining worldwide. Infection with this bacterium has been established as a causative factor in the development of peptic ulcer disease and with the development of gastric malignancies, including gastric adenocarcinomas and gastric lymphomas (ref. 2)
The epidemiology of this infection reflects a pattern typical of fecal-oral transmission and is similar to hepatitis A or polio, prevalent at a young age in developing and poor countries (ref.1)
Pernicious Anemia: About 90% of patients with pernicious anemia have antibodies against parietal cells of the gastric lining eventually leading to depleted serum levels and body stores of vitamin B12 and a megaloblastic anemia. Pernicious anemia is also associated with other immunologic disorders (e.g., Hashimoto's thyroiditis, hyperthyroidism, insulin-dependent diabetes mellitus, and vitiligo).
Genetic factors are important in pernicious anemia as family members of patients have an increased incidence of atrophic gastritis; achlorhydria (diminished or no production of HCl acid); vitamin B12 malabsorption; and antibodies to intrinsic factor, a substance secreted by the gastric lining and important in binding B12 vitamin. Gastric adenocarcinomas (malignancies) have been reported to occur with increased frequency with pernicious anemia.

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Chronic, Nonspecific Gastritis
Although most forms of chronic, nonspecific gastritis are clinically silent, of importance is that these forms of gastritis represent risk factors for other conditions such as peptic ulcer disease and gastric cancers. It is widely believed that the most common condition associated with chronic active, non atrophic gastritis is duodenal ulcer disease.

The Rare Forms of Gastritis:
Infectious Gastritis: Gastrointestinal Cytomegalovirus (CMV) infection usually occurs in the immunocompromised patient. Patients with CMV infection of the stomach may experience epigastric pain, fever, and atypical lymphocytosis. Upper gastrointestinal tract radiographic studies may reveal findings suggestive of an infiltrating malignancy. Gastric involvement with herpes simplex and varicella/zoster virus on the other hand is rare. Infected individuals experience the infection at an early age, and the virus remains dormant until reactivation.

Another form of gastritis, called Phlegmonous gastritis is a rare bacterial infection of the stomach. Acute necrotizing gastritis and phlegmonous gastritis have been associated with recent large intake of alcohol, upper respiratory tract infection, and AIDS.
Emphysematous gastritis is characterized by air in the wall of the stomach due to invasion by gas-forming microorganisms such as Clostridium welchii. Predisposing factors are gastro duodenal surgery, ingestion of corrosive materials, gastroenteritis, or gastrointestinal infarction. (ref.4)
Gastric tuberculosis usually occurs in association with pulmonary tuberculosis. Patients typically present with abdominal pain, nausea and vomiting, gastrointestinal bleeding, fever, and weight loss.
Gastritis in Syphilis: From the literature surveyed, it is important to recognize early the features of syphilis in the stomach as this provides an opportunity for effective antibiotic therapy to stop the disease's progress and the cause of permanent disability.
The stomach is rarely involved in parasitic or fungal infections and that is mainly in immunocompromised patients.

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Management of Gastritis
Gastritis by itself is rarely considered a serious problem.
The treatment of gastritis will depend on its cause. For most types of gastritis, reduction of stomach acid by medication is often helpful. Beyond that, a specific diagnosis must be made. Antibiotics are used in cases of infection. Stopping taking aspirin, NSAIDs or alcohol is advised when one of these is the problem. For the more unusual types of gastritis, other treatments are needed.
In some cases, as in young adults, where are no other symptoms but pain and indigestion associated after intake of meals, simply changing some eating habits might be extremely helpful.
Self-directed therapy should include taking regular meals, sitting comfortably at the table while eating food, and most importantly taking small and manageable for chewing bites in addition to chewing the food properly and for longer period of time before swallowing it, and drinking plenty of water with any meal. These habits should be encouraged in otherwise healthy children who often complain of stomachache after meals.

In case of GERD the following activities should be avoided: eating before retiring at night; wearing tight garments and heavy physical exercise after meals; taking anticholinergic drugs or consumption of foods or substances that decrease the lower esophageal sphincter (muscle)tone, such as cigarettes and alcohol; and direct irritants to the esophagus such as coffee, citrus fruit, and tomato-based products. (ref.3)

Last Thought

In otherwise healthy adults, starting to experience upper abdominal pain after meal, changing one's eating habits and adopting the simple measures for healthy life style should be tried first. In short, good eating habits are worth following, such as eating nutritious meals regularly, making time for each and every meal and chewing the food longer before swallowing, and drinking plenty of water while eating. In addition, avoid activities such as heavy meal before night rest, consumption of alcohol and cigarette smoking, and anything else that noticeably upsets one's stomach.

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References and Links

Jackson Gastroenterology

E-Medicine

Health Link

HealthWell

The Canadian Helicobacter pylori Site

HealthSquare

References:

1.Goldman: Cecil Textbook of Medicine, 21st ed., (ref. 1)

2. American Journal of Clinical Pathology, Selections from 2003 - Volume 119, Number 5 (ref. 2)

3. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., p. 738:742

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