10.3: Gastritis III: Clinical Manifestations and Management

The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.

Clinical manifestations of acute gastritis

The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as melena or hematochezia.

Clinical manifestations of chronic gastritis

The patient with chronic gastritis may complain of fatigue, pyrosis after eating, belching, a sour taste in the mouth, halitosis, early satiety, anorexia, or nausea and vomiting. Some patients may have only mild epigastric discomfort or report intolerance to spicy or fatty foods or slight pain relieved by eating. Patients with chronic gastritis may be unable to absorb vitamin B12 because of diminished production of intrinsic factors by the stomach's parietal cells due to atrophy, which may lead to pernicious anemia.

Diagnostic evaluation

Diagnosing acute gastritis involves evaluating the patient's symptoms and considering any risk factors present. Sometimes, an endoscopic examination with a biopsy may be necessary to confirm the diagnosis. Various tests may be conducted to evaluate for H. pylori infection, including breath, urine, serum, stool, and gastric tissue biopsy. A complete blood count can also indicate anemia resulting from blood loss or lack of intrinsic factor, while stool tests can detect occult blood. Serum tests for intrinsic factor and antibodies to parietal cells may also be performed. Lastly, a tissue biopsy can effectively rule out the presence of gastric cancer.

Management

Managing gastritis involves addressing the underlying cause, alleviating symptoms, and promoting the healing of the gastric mucosa. Here are some commonly used methods for managing gastritis.

Drug therapy aims to alleviate irritation of the gastric mucosa and provide symptomatic relief. Commonly prescribed drugs are antacids, histamine-2 receptor antagonists, or H2 blockers, for instance, famotidine and cimetidine, proton pump inhibitors like omeprazole or lansoprazole, and intravenous fluids. Severe cases may require emergency surgery to remove gangrenous or perforated tissue. While not directly caused by gastritis, these complications can occur secondary to worsening conditions.

Chronic gastritis management involves dietary modification, including the avoidance of spicy and fatty foods, rest, stress reduction, and abstaining from smoking, alcohol, and NSAIDs. H. pylori is treated with drug combinations, typically including a proton pump inhibitor, antibiotics, and sometimes bismuth salts. This comprehensive approach aims to improve symptoms, promote healing, and address the underlying factors contributing to gastritis.

Acute gastritis manifests with a sudden onset of symptoms, including epigastric pain, dyspepsia, anorexia, hiccups, nausea, and vomiting.

Hematemesis and melena are noticed in hemorrhagic gastritis, indicating bleeding in the stomach.

Conversely, chronic gastritis presents with fatigue, belching, halitosis, early satiety, anorexia, nausea, and vomiting.

Other symptoms include mild epigastric discomfort, spicy food intolerance, slight pain eased by eating, and pernicious anemia.

Next, acute gastritis is diagnosed primarily based on symptoms. To determine H. pylori infection, urea breath tests, urine, serum, stool studies, and gastric tissue biopsy tests are recommended.

Occult blood testing in stools and serum tests for intrinsic factors and antibodies to parietal cells can further aid diagnosis.

Lastly, gastritis management involves drug therapy comprising antacids, H2 blockers, proton pump inhibitors for irritation, antibiotics for H. pylori infection, and antiemetics for vomiting.