STOMACH ULCER 1 (What No One Is Talking About)

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Topic:  GASTRITIS

What is gastritis and why does it matter


                 Patient complaints:




                                      - Abdominal discomfort
                                      -Nausea and vomiting
                                      -Belching and bloating




Introduction

Stomach is an organ located in the upper part of the abdomen called epigastrium while epigastrium is a centrally located region in the upper abdomen. Gastrium is a medical term for stomach






Definition

This is inflammatory changes of the gastric mucosa membrane and a common problem presented to the doctors in the hospital.
It is also a foundation for the common term called ulcer.


 Types of Gastritis

Acute Gastritis of the Stomach: Inflammatory changes that last several hours or few days and, can proceed to chronic gastritis after several episodes of exposure to irritating agent.

Chronic Gastritis of the Stomach: A prolonged inflammatory changes that results from recurrent episodes of the acute gastritis via repeated exposure to irritating agent and last more than several days.


 Etiology (causative agents)

There are various causes of gastritis and listed below are the causative (offensive) agents from the common to the least.

A. Medications (drugs): The most common culprit drugs are the analgesics, pain relievers. This is   commonly used by women of reproductive age for menstrual pain, others include patient with arthritis, spondylosis (low back pain), general body/bone pain.

These drugs are available in various forms over the counter (chemist, pharmacy).  Examples include Diclofenac (traded in various form such as osteos, lofenac), ibuprofens (ibucap, ibrupain and ibudex), proxiam (felvin) and naproxen to mention a few and all these can be given orally and by injection.

The use of these drugs repeatedly and even at normal dose for prolong period inhibit the defensive factors production and mucosal irritation, even though the pain has subsided or stopped.

Other common drugs include aspirin, iron, and cocaine .

 B.  Alcohol such as gin, vodka and whisky and smoking causes mucosal irritation.

All these drugs, alcohol and smoking cause mucosal irritation resulting into inflammation of the stomach.
 
C. Infection, the most common one is helicobacter pylori, a bacterium that has been implicated to cause ulcer and commonly associated with chronic gastritis. 
                                                                              
Others are fungi infections such as candidiasis which is common in an immunocompromised patient such as HIV/AID, cancer and severe sepsis.

D. Bile acid reflux and Ingestion of strong acid and alkali.

E. Radiation therapy and direct trauma.

F. Too highly seasoned food and allergy and food poisoning.

G. Pregnancy

J. Acute shock and severe infection

Mechanism

Our stomach has a mucosa lining that secrete the defensive (protective) agents, these include Hydrochloric acid (acid)  and other fluids that aid digestion.

Bicarbonate and mucus that help in mopping up and neutralizing the excess acid thereby, preventing mucosal damage.

Prostaglandin that aids mucus production thereby reducing acid damage to the mucosa.

Note that, this acid does not prevent against infections.

This stomach disorder, gastritis, results from imbalance between the offensive factors i.e. causative agents and defensive agents i.e. protective agent of the stomach that maintain the integrity of the mucosa membranes.

Leading to edematous and hyperemic stomach mucosa membrane i.e. the stomach lining is congested with fluid and blood.
There is also superficial erosion, little acid secretion and much mucus production.

Inhibition of prostaglandin production by the use of analgesic for pain reliver  in various form affect the defensive action against acid damage.





Clinical Manifestations

The signs and symptoms for gastritis include the following,

Mild epigatric pain, an upper abdominal pain that is centrally located

Nausea and/or vomiting

Belching and bloating

Anorexia, hiccups and indigestion

Complications of gastritis

These are the consequences from the stomach disorder, gastritis.

Peptic ulcer disease from the erosion of gastric mucosa membrane (the stomach lining) .

Hemorrhages (internal bleeding from the ulcer)

Dehydration from several episodes of vomiting

Perforation as a result of deep erosion of the stomach mucosa

There are other complications that I did not mention here, all because it requires doctors’ diagnosis and are better managed in the hospital setting including bleeding and perforation mentioned above.

Treatments

The treatment of gastritis is in two ways

1. Lifestyle and dietary modification

2. Chemotherapy

These two management methods will be discussed in the next topic called peptic ulcer disease, because they are treated in the same manner.

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