Acute Gastritis

What is acute gastritis?

When something interferes with the protective mechanisms of the stomach, a range of problems can occur from mild indigestion to deadly bleeding ulcers. Gastritis is an umbrella term for one of the most common problems, inflammation of the stomach lining.

Symptoms include nausea or vomiting, a loss of appetite, belly pain, bloating, or passing blood in severe cases.

While chronic gastritis can be a lifelong affliction, acute gastritis clears up within days to weeks of onset.

Recommended care

You should see your doctor within a few days. There, they would assess whether you require a breath test for the bug, H. Pylori, and/or a test where they put a camera down the throat to look at the stomach wall. Treatment is dependent on the outcomes of the doctor's visit. If it's just because of a medication, the first treatment would be to stop it. If it's an infection, antibiotics would be appropriate. An autoimmune reaction might require supplements with Vitamin B12. Taking an antacid may be necessary for more than one of these scenarios.

Symptoms of acute gastritis

The lining of your stomach, the gastric mucosa, is under constant assault. It lives in a bath of hydrochloric stomach acid. It has to tolerate everything we eat and drink, and stand up to the enzymes your body uses to break those things down. Gastritis, discussed prior, is inflammation of the stomach lining due to a failure of total protection.

Main symptoms

Many people with gastriris have no symptoms at all. When symptoms do occur, they are often vague. In general, the symptoms resemble what most people would call an "upset stomach" or bellyache. These common symptoms include the following:

• Nausea or vomiting
• Loss of appetite
• Belly pain: Primarily in the upper abdomen
• Feeling bloated: Particularly after eating

Erosive gastritis

Sometimes, the same things that cause gastritis can wear down the stomach lining to the point that a sore opens up, known as an ulcer. During this more severe form, known as erosive gastritis, there can also be bleeding into the stomach. Some symptoms that indicate this may have occurred include the following.

• Vomiting blood (hematemesis): Vomit may be red or have a "coffee-ground appearance"
• Black or bloody stools (melena)
• Fatigue, dizziness or fainting: This can result if there is significant blood loss (known as anemia)

Causes of acute gastritis

In general, gastritis occurs when the stomach's protective mechanisms are overpowered by the things they have to protect against. This can happen because the protections have been weakened or because the attack has worsened. Most often, it's some combination of the two. Things that tend to disrupt this balance include the following.

Anti-inflammatory medications

These include steroids like prednisone or methylprednisolone (Medrol) and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil/Motrin), naproxen (Aleve) and aspirin. When NSAIDs reduce inflammation, they also decrease some of the protective mechanisms keeping the stomach healthy. In small doses the effect isn't noticeable, but with large doses and regular use, conditions like gastritis set in.

Infection with H. pylori

H. pylori is a bacteria that infects the digestive tract and attacks the stomach lining. For many years it was believed that no bacteria could survive in the acidic environment of our stomachs. Dr. Barry Marshall infected himself with H. pylori to convince the scientific community of its role in stomach disease. For his efforts, Dr. Marshall was awarded the Nobel Prize, largely because studies found H. pylori as the most common cause of gastritis worldwide.

Excess alcohol consumption

This is another common cause of acute gastritis. This usually requires large quantities consumed regularly, but some people are more susceptible than others and can experience stomach irritation from relatively small quantities of alcohol.

Rarer causes

The consumption of certain caustic substances (such as during a suicide attempt) or the use of illicit drugs (specifically cocaine) can cause significant damage to the stomach lining. The same is true of exposure to large doses of radiation, typically as part of cancer treatment. Certain autoimmune diseases, where the body gets attacked by its own defense systems, can also target the stomach lining. Lastly, almost any type of very severe illness can disrupt the body's protective mechanisms can cause stress gastritis.

Treatment options and prevention for acute gastritis

Many cases of acute gastritis will go away on their own. When treatment is needed, it begins with addressing the underlying cause. If medications such as NSAIDs are contributing to gastritis, your physician will likely advise you to stop taking them or to reduce the dose. If you use cocaine or consume alcohol in excess, quitting these substances will often go a long way to alleviating gastritis.

Reducing stomach acid

Reducing stomach acid often plays an important role in treating acute gastritis. This can be done in several ways including the following.

• Antacids: Aluminum hydroxide (Tums) work by directly neutralizing stomach acid. This makes them very fast-acting but generally not a good long-term solution and less effective than options which reduce acid production.
• H2 antagonists: These include famotidine (Pepcid) and ranitidine (Zantac). These block one pathway of stomach acid production but not others.
• Proton pump inhibitors (PPIs): These include omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix) or lansoprazole (Prevacid). These medications block multiple pathways of stomach acid production at once, causing significant reductions in stomach acidity. This makes them very effective at reducing symptoms caused by excess stomach acidity, but also means they cause significant changes from the digestive system's natural balance. They have been associated with a number of side effects[8]. Several are now available over-the-counter, but given the known risks it's worth talking with your physician before starting a PPI regimen.

Triple therapy for H. pylori

For gastritis caused by H. pylori infection, treatment consists of both acid suppression and antibiotics. H. pylori can be a difficult bacteria to fully eliminate, and it can cause serious complications if insufficiently treated. Therefore a combination of two antibiotics is often used along with a PPI, a regimen known as triple therapy. A 2019 study found the levels of vitamin D can increase the eradication rate of H. pylori infection treatments.

Prevention

As with many medical conditions, prevention of gastritis consists mainly of avoiding known risk factors. Some of these are easier to avoid than others. Not using cocaine and only consuming alcohol in moderation can not only reduce the risk of gastritis but also improves many other facets of your overall health.

Another major step you can take to reduce the risk of gastritis is limiting the use of anti-inflammatory medications (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve). If you find yourself taking anti-inflammatories multiple times a week or in doses approaching the recommended limits, it's worth talking with your physician about other options for pain control.

Avoiding H. pylori is more difficult. Unfortunately, it's still not known exactly how H. pylori infection is transmitted. Current theories suggest it may be passed from person to person, either directly in body fluids or through contaminated food or water. Therefore, the best steps to avoid H. pylori infection would include washing hands thoroughly and maintaining sanitary living conditions. It's also advisable to only consume food that is properly prepared and water that is known to be from a safe drinking source.

As with H. pylori, it's also hard to prevent gastritis caused by rarer conditions such as severe illness or autoimmune disease. In those cases, the best option is to treat the underlying condition to the best extent possible and to appropriately treat any gastritis that does occur.

When to seek further consultation for acute gastritis

Most cases of gastritis aren't dangerous or serious, but they can be quite unpleasant. Anyone who is significantly bothered by their symptoms should schedule an appointment with their physician. The same is true for anyone whose belly pain or nausea does not improve over time. Symptoms that may indicate a more serious problem include unexplained weight loss, black or bloody stool, persistent vomiting or a prolonged inability to tolerate anything by mouth. While these are not proof of serious illness, they are concerning enough to schedule an appointment sooner rather than later.