Gastritis III: Clinical Manifestations and Management

Acute gastritis manifests with sudden onset symptoms including epigastric pain, dyspepsia, anorexia, hiccups, nausea, and vomiting lasting from hours to days. Hemorrhagic gastritis may cause bleeding visible as hematemesis (blood in vomit) or melena (dark stools), indicating active gastric bleeding.

Chronic gastritis develops gradually with fatigue, belching, halitosis, early satiety, anorexia, nausea, and vomiting. Patients report mild epigastric discomfort, intolerance to spicy foods, and pain relieved by eating. Chronic cases may cause pernicious anemia due to diminished intrinsic factor production by atrophied parietal cells, impairing vitamin B12 absorption.

H. pylori infection is diagnosed using urea breath tests, urine, serum, and stool studies, plus gastric tissue biopsy. Occult blood testing in stools detects bleeding, while serum tests measure intrinsic factors and antibodies to parietal cells. Endoscopic examination with biopsy confirms diagnosis and rules out gastric cancer.

Proton pump inhibitors like omeprazole and lansoprazole reduce gastric acid irritation and are central to gastritis drug therapy. They alleviate mucosal irritation and provide symptomatic relief. For H. pylori treatment, proton pump inhibitors are combined with antibiotics and sometimes bismuth salts to eliminate infection and promote healing.

Chronic gastritis management includes dietary modification by avoiding spicy and fatty foods, rest, and stress reduction. Patients must abstain from smoking, alcohol, and NSAIDs, which irritate the gastric mucosa. These modifications, combined with drug therapy, promote healing and address underlying factors contributing to gastritis.

Chronic gastritis causes atrophy of gastric parietal cells, reducing intrinsic factor production necessary for vitamin B12 absorption. This deficiency leads to pernicious anemia. A complete blood count reveals anemia from blood loss or lack of intrinsic factor, while serum tests confirm antibodies to parietal cells.

Severe gastritis 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. Surgical management and nursing care become necessary when conservative drug therapy and dietary modifications fail to prevent tissue damage.