Chronic gastritis

International Classification (ICD)	K29.-
Symptoms	Indigestion, Anemia, Flatulence, Diarrhea, Feeling of fullness, pain below the diaphragm
Possible causes	Viruses, bacteria and fungi, Allergies, Crohn's disease, Alcohol or medication, bile reflux, Autoimmune diseases, Helicobacter pylori
Possible risk factors	Stress, Runner's Stomach, stomachic stimulants, Painkiller, mechanical irritations, Food poisoning, excessive alcohol and tobacco consumption, large quantities of coffee, poor diet
disease.contra_indicated_substances	Ibuprofen, Acetylsalicylic acid (ASA)

Basics

Gastritis, also called gastric mucosa inflammation, is an inflammation-related damage of the gastric mucosa(lat. Tunica mucosa gastrica). Depending on the variation, superficial to deeper changes in the glandular tissue may occur.

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Depending on the course of the disease, a distinction is made between acute and chronic gastritis. The latter usually develops gradually and sometimes manifests itself late with rather unspecific symptoms. Chronic gastritis is basically divided into three types, which are distinguished by different causes.

Causes

Type A - Autoimmune gastritis

Origin

In autoimmune diseases, the human immune system produces antibodies against the body's own cells or cell components. In the case of autoimmune gastritis, antibodies against an acid-forming protein (^H+/K+-ATPase) of the gastric vestibular cells and/or intrinsic factor are known.

Stomach cells are cells in the gastric mucosa that are responsible for the production of hydrochloric acid (a component of gastric juice, HCl) and intrinsic factor (a protein for the absorption of vitamin B12 in the small intestine). The inflammation caused by the autoantibodies leads to the death of the gastric mucosa cells and to the atrophy of the gastric mucosa.

The development of type A gastritis may also involve Helicobacter pylori bacteria, which are otherwise associated with type B gastritis.

Frequency

Autoimmune gastritis is the rarest form of chronic gastritis, accounting for 3-6% of all cases. It may have a hereditary component and affects almost exclusively Northern Europeans or Scandinavians.

	Type B - Bacterial gastritis
Origin	Type B gastritis is caused by the bacterium Helicobacter pylori, which is transmitted from person to person.
Frequency	Type B gastritis accounts for about 80-90% of all chronic gastritis and is the most common subtype. The number of people affected increases correlatively with age, as H. pylori contamination increases. There is hardly any disease below the age of 20.

Type C - Chemical gastritis

Origin

Type C gastritis is caused by a chemical-reactive irritation of the stomach.

This can be caused, for example, by non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, acetylsalicylic acid, naproxen or diclofenac. Their use inhibits the formation of the tissue hormone prostaglandin, which is responsible for the formation of gastric mucus and gastric acid neutralizing substances.

Other substances such as nicotine and alcohol and, in rarer cases, reflux (backflow) of bile can also be responsible for type C gastritis.

Frequency

About 10-15% of all chronic gastritis cases are chemical gastritis.

Special forms

Gastritis in the context of chronic inflammatory diseases such asCrohn's disease
Gastritis in systemic diseases such as sarcoidosis or amyloidosis
Lymphocytic gastritis: gastritis with typical histological changes, associated with celiac disease or H. pylori.
Eosinophilic gastritis: partly associated with allergies such as wheat, cow's milk or soya
Infectious gastritis caused by bacteria, fungi and viruses: e.g. anthrax, Candida spp. and herpes simplex virus

Symptoms

Chronic inflammation of the gastric mucosa often causes no or uncharacteristic gastrointestinal symptoms. Acute gastritis with corresponding symptoms is possible in the setting of chronic gastritis.

Type A	Vitamin B12 deficiencyDue to the damaged supporting cells in the stomach, the intrinsic factor is produced in a diminished manner. This is essential for the absorption of vitamin B12. Gastritis thus leads to vitamin B12 deficiency, which can manifest itself as pernicious anemia (anemia).
Type B	Type B gastritis does not cause specific symptoms. However, there is an increased risk for: Gastric and duodenal ulcers. Type A gastritis gastric cancer (carcinoma, MALT lymphoma)
Type C	This type of gastritis also shows only non-specific symptoms, which are similar to those of acute gastritis. Possible complications are gastric bleeding and ulcers.

Diagnosis

AnamnesisDuring the anamnesis (questioning about the medical history), information about lifestyle habits, previous illnesses and the use of medication can provide indications for chronic gastritis.
Physical examinationSubsequently, the abdominal region is examined. Palpation of the abdomen may elicit a possible tenderness, which, due to its localization, may also be an important clue to possible other diseases. Palpation including the liver and spleen may also reveal indurations. In addition, the doctor listens to the bowel sounds with a stethoscope (auscultation). By tapping the abdomen, accumulations of air or fluids can be registered.
EndoscopyTo clearly detect chronic gastritis, a gastroscopy can be performed. For this purpose, a tube with a camera is inserted into the stomach via the mouth. Often, visually visible changes in the gastric mucosa are already an indication of gastritis. In the course of a biopsy, tissue samples can also be taken with a small forceps. These samples can be examined for infectious agents or cell changes in order to diagnose or rule out more dangerous clinical pictures, such as stomach cancer or stomach ulcers. The bacterium H. pylori is also usually detected by biopsy.
Breath test or blood/stool examinationTo diagnose an infection with Helicobacter pylori, the pathogen can also be detected with special tests. The germ can be detected via breath test, stool test or blood test. Blood tests for specific antibodies can provide evidence of autoimmune gastritis (type A). A vitamin B12 deficiency or a resulting pernicious anemia can also indicate chronic gastritis.

Therapy

Type A

A way to treat the cause of autoimmune gastritis does not yet exist. In case of an existing vitamin B12 deficiency, a (often lifelong) substitution of the vitamin is carried out. If H. pylori is detected, it should be eradicated (see below).

Type B

The first priority in bacterial gastritis is the eradication of Helicobacter pylori. For this purpose, there are different therapy regimens which are selected according to the resistance situation and individual factors:

First-line therapy(approx. 10-day course).	Bismuth-containing quadruple therapy: Metronidazole + tetracycline + PPI + bismuth.
Second-line therapy(approximately 14-day course).	Triple therapy: Italian regimen: PPI + clarithromycin + metronidazole. French regimen: PPI + clarithromycin + amoxicillin

If therapies are unsuccessful, testing for antibiotic resistance should be performed.

Type C

Avoid triggering substances: in this type of gastritis, it is often sufficient to avoid or discontinue the triggering substances.
Support peristalsis: this can be done with prokinetics such as metoclopramide or domperidone if bile reflux is the cause.
Proton pump inhibitors (PPI): another therapeutic option is the use of proton pump inhibitors.

Supportive measures

All recommendations that apply to acute gastritis can also alleviate the symptoms of chronic gastritis. These include a light diet, avoidance of coffee, alcohol and nicotine, stress reduction and adequate fluid intake.

Forecast

Chronic gastritis can last from several weeks to years. Depending on the cause, chronic gastritis can also heal without complications.

What the prognosis is depends on the type of gastritis:

Autoimmune gastritis (type A) cannot be cured, but usually causes few symptoms. Sufferers are usually dependent on the administration of vitamin B12 for the rest of their lives. Control examinations are very important, as there is an increased risk of stomach cancer.
In bacterial gastritis (type B), the success rate of eradication therapy for Helicobacter pylori is 80-90%. Again, check-ups are recommended because of the increased risk of gastric cancer, MALT lymphoma, and gastric or duodenal ulcers.
Chemical reactive gastritis (type C) has a very good chance of cure. Once the cause has been eliminated, the mucosal inflammation usually heals quickly and without complications.

Illustration of the stomach with gastritis

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Erosions (superficial defects of the gastric mucosa with intact gastric wall) in acute or chronic form are also possible. They are the symptom of various damages or diseases, but the exact cause usually remains undiscovered.

In order to detect and treat gastric carcinomas at an early stage, regular gastroscopy is recommended in cases of chronic gastritis.