GASTRITIS (ACUTE OR CHRONIC)

Gastritis, whether acute or erosive, begins when the stomach’s protective mucosal barrier is disrupted. This damage exposes the underlying tissue, triggering inflammation as the body tries to defend itself.

In response, the immune system sends its first responders (neutrophils) rushing into the inflamed area. This process, known as neutrophilic infiltration, is commonly seen in infections, injuries, or inflammatory diseases like appendicitis and ulcerative colitis. When doctors perform a biopsy, they can actually see these neutrophils accumulating in areas where they normally wouldn’t be present.

The breakdown of the mucosal layer ultimately leads to reduced mucus production, leaving the stomach lining even more vulnerable and weakening its ability to protect itself against further injury or infection.

Involves short-term inflammation of the stomach lining, caused by sudden irritation (e.g., infection, alcohol, NSAIDs, stress). Symptoms are often sudden and short-term (hours to days).

• Sharp stomach pain
• Burning feeling in upper abdomen (especially after eating)
• Nausea
• Bloating or indigestion
• Loss of appetite and/or feeling full quickly
• Black or tarry stools (from internal bleeding)
• Vomiting blood (severe cases)

Involves long-term inflammation that develops slowly over time, often caused by an H. pylori infection (most common), autoimmune reactions (when the body attacks stomach cells), alcohol use or long-term NSAID use (Non-Steroidal Anti-Inflammatory Drugs such as Ibuprofen, Aspirin and Diclofenac amongst others) all of which leads to gradual damage, thinning of the mucosa, and sometimes ulcers.

Symptoms are often milder but more persistent and develops slowly over time, lasting for months or years.

• Sharp stomach pain
• Burning feeling in upper abdomen (especially after eating)
• Nausea
• Bloating or indigestion
• Loss of appetite and/or feeling full quickly
• Persistent fatigue (due to nutrient malabsorption or anaemia).
• Gradual weight loss
• Vitamin B12 deficiency (in autoimmune types)
• Complications like ulcers, atrophic gastritis, or even stomach cancer if untreated

When the immune system attacks stomach cells, especially parietal cells and leads to Vitamin B12 deficiency and pernicious anaemia. This is associated with increased risk of stomach cancer.

This is the most common type of Gastritis worldwide, caused by Helicobacter pylori infection and leads to ulcers, chronic inflammation, and increases risk of stomach cancer.

This is less immune-driven and more of a “chemical injury”, caused by chemical irritants like, bile reflux (bile flowing backward from intestine into stomach), Chronic NSAID or alcohol use.

Erosive Gastritis: This is a severe form of Gastritis causing surface erosions, bleeding, but not always deep ulcers and is common in critically ill patients (e.g., ICU).
Atrophic Gastritis: Is the severe thinning and loss of stomach lining due to long-term inflammation (often from H. pylori or autoimmune causes).
Phlegmonous Gastritis: Is a rare, severe bacterial infection causing purulent (pus-filled) inflammation and is considered life-threatening.
Lymphocytic Gastritis: Is characterised by high lymphocyte (immune cell) infiltration and is sometimes linked to celiac disease.

An Upper Endoscopy with biopsy is the gold standard as it directly allows for viewing of the stomach lining, whilst taking tissue samples to confirm gastritis and rule out H. pylori or precancerous changes.
H. pylori Testing (Stool Antigen Test or Urease Breath Test): a non-invasive tests that check for H. pylori infection — a major cause of chronic gastritis.

Proton Pump Inhibitors (PPIs) (e.g., omeprazole) which reduce stomach acid and promotes mucosal healing. This is common for Acute Gastritis and Autoimmune Gastritis.

H. pylori Eradication Therapy (2 antibiotics + PPI) eliminates H. pylori infection, stopping the cause of chronic inflammation. This is common in Chronic H. pylori Gastritis.
– Stage 1: Antibiotic + PPI
– Stage 2: Different antibiotic + PP

Antacids (e.g., calcium carbonate) provides temporary acid neutralisation and only provides symptom relief. Dietary Changes (low-acid, low-irritant foods) reduces irritation and stress on the stomach lining